NY auto insurance from the Lang Agency, LLC
NY auto insurance from the Lang Agency of New York
NY auto insurance from The Lang Agency LLC
NY home  insurance quotes
ny car insurance quotes from The Lang Agency LLC

Come Visit Us in Middletown, NY!
the Lang Agency, LLC
The Lang Agency, LLC
22 County Route 78,
Suite 2
Middletown, NY 10940
(Click for Office Map/Directions)

Local Phone:


Order Our Free Money Saving Report:
The Lang Agency LLC offers online auto and home insurance quotes Get Our Free Report!

"12 Ways to Save Money on Your Auto Insurance"
Your Name
Your Email

Visit Our Agency's Other On-Line Quote Forms and Start Saving!
Auto Insurance Quote

Home Insurance Quote

Motorcyle Ins. Quote

R.V. Insurance Quote

Classic Car Quote

Boat Insurance Quote

Renters Insurance Quote

Condo Insurance Quote

Commercial Auto Quote

Flood Insurance Quote

Personal Umbrella Quote

Life Insurance Quote

Defensive Driver Program

About Our Agency

Office Map/Directions

Policy Service Request

Privacy Notice

The Lang Agency LLC - new york insurance agency

Homeowners Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!

Your Personal Data:
Your Name:
Property Address:
Your "County" is?
State: (Must be New York)
E-Mail again for accuracy:
Fax (optional):
Primary Insured's Occupation:
Primary Policyholder's Birthdate:
(REQUIRED - Some companies products
offer discounts for certain age groups.)
Dwelling Information
Year Home Built:
Home Square footage:
Is this Builder's Risk?
(new home constr.)
Month/Year home
to be complete:
Number of units: 1 family Duplex
Type foundation: Basement
Crawlspace over slab
Other (list in remarks)
(If basement, what % is finished?)
Type Construction: Frame
Other (list in remarks)
Type Roof: Shingle
Wood Shake
Spanish Tile
Metal Other
Number of stories: One 1.5
Two Three
Do you own animals or pets? Yes No
If yes, list type/for dogs, list breed:
Are You Near Brush Area? Yes No
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
Does Home Have a Garage? Yes No
Tell whether built in, detached/attached, and how many cars?
Currently Insured? Yes No
Name of Carrier & how long insured?
Prior Claims? Yes No
Describe claims in detail:
Rate Your Credit History and Past Insurance Payment History:
(Some companies products are
based on your credit and payment history.)
Excellent Fair
Poor Horrible
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
Heating Type: Gas (Propane or natural)
Oil (if oil, list tank location in remarks)
Circuit Breakers or fuses? Breakers Fuses

# Bedrooms: # Bathrooms:
# Fireplaces: # Chimneys:
Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)
Dwelling Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
(describe any scheduled jewelry, in-home business, oil tank location, or other special coverages/remarks here):
Send my quotation via: E-Mail Fax
Regular Mail
Call Me By Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a Quote NOW!

Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!

NY auto and homeowners insurance
Helpful terms used to find us in most major search engines: New York auto insurance, NY auto insurance, New York home insurance,
NY home insurance, New York life insurance, NY life insurance, low cost New York car insurance, discount new york homeowners insurance,
fast and free NY term life insurance quote, discount new york personal and business insurance.

Web Site Design © 2012, Insurance Web Sales