Quick Homeowners or Renters Quote Via the Internet

 

As we are only licensed to sell insurance in certain states, please fill out this form only if you live in Maryland, Virginia, Delaware, or the District of Columbia.

 

Name:
Street:
City: State: Zip Code:

Construction:

BRICK
FRAME

Year built:

Name of current insurance company: Exp. Date:

Please list all claims in the past 3 years:


Please advise current insurance limits:

Dwelling:
Personal Property:
Deductible:
Personal Liability:
Medical Payments:

Additional coverages:

Replacement cost dwelling
Replacement cost contents
Water back up/sewers & drains
Scheduled Property (jewelry, furs, silver, etc.)
Additional Residence

Credits available for the following:

Smoke detector
Deadbolt locks
Central alarm (burglary & fire)
Non smoker

Other Information

Please enter any additional information you would like us to know and provide your email address, fax number, and/or phone number.



Send only once, there is no confirmation.

Thank you for taking the time to fill out our form, we will be getting back to you with a quote as soon as possible.



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Martens-Johnson Insurance Agency
6227 Executive Boulevard, Rockville, MD. 20852
Telephone:301-231-5447 Fax:301-881-1137
Email:info@mjia.com