"Your Insurance Resource Center"
 





(631) 207-5400



SAVE AN ADDITIONAL 10% ON YOUR
CAR INSURANCE!

COMPLETE OUR ONLINE DEFENSIVE DRIVING COURSE NOW!

Click on the banner to enroll in our NY state-certified program.


IMPROV Comedy Traffic School


View Sharon Hamilton's profile on LinkedIn


Contact Us

CALL US
(631) 207-5400

FAX US
(631) 207-5401

E-MAIL US
info@centennialagency.com




NOT A CUSTOMER YET?

Click here to find out why you should be!



Customer
Testimonials


Testimonial
Click on the pictue
to visit this valued
customer's website
or click here to see
our next testimonial.



 
Homeowners Insurance Quote

Complete the short form below and we will get back to you with your free quote


General Information

Full Name:  
 
Street Address:  
 
City, State & Zip:  
 
E-Mail Address:  
 
Day Telephone:  
Eve Telephone:  
Best Time To Reach You:
Fax:  
Your occupation:  
Date of Birth:  

Current Insurance Information
Insurance Company Name:  
(NOT Insurance Agency/Broker) 
Policy Exp. Date:  
Amount Insured for:  
Mortgage Amt:  
Premium Amt:
Term:  
Any Claims in Last 3 years? 

Information About Your Home:
Year Home Built:  
Total Square Feet:  
Yrs @ address:  
Deductible:
Liability coverage:  
Market Value:
Distance to nearest fire hydrant:       
Distance to nearest fire department:  
Home Type:  
Home Construction:  
Roof Type:  
Garage Type:  
Age of roof:  
Garage:  
# of Bedrooms:  
# of Fireplaces:  
# of Bathrooms:  
Exterior:  
Foundation: Basement Finished?
    If finished, what %? %

Additional Information
Swimming Pool?:  
Pool Fenced:  
Diving Board:  
Trampoline:  
Smoke Detector:  
Security System:  
Heating System:  
Fire Alarm:  
Replacement cost of personal items:  
Any business conducted in home:  
List values of any jewelry,
furs, or specialty items:  
List pets &
breeds:  
Do you want to include Flood Insurance?:  

Additional Comments
Please provide additional comments or questions you may have

No coverage of any kind is bound or implied by submitting information via this online form

  • We will only use information provided to assist in obtaining appropriate insurance quotes and coverage.
  • We will not distribute information to other parties other than for insurance underwriting purposes.
  • By checking the box below you agree to release us from any liability should this information be accidentally viewed by others.

YES! I Agree

PIA Logo Centennial Insurance Agency, Inc
"Your Insurance Resource Center"

Give us a Call Today!
(631) 207-5400
Medford Chamber of Commerce