Empire Insurance Services LLC
Empire Quote Intake
(518) 350-0511
Quote type
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Quote request type
New home closing
Insurance review
Contact
Borrower Information
Full name
Date of birth
Email
Phone
Occupation
Referral source
Spouse name, if applicable
Spouse date of birth
Anyone else listed on the deed
Any other drivers in the household
Current housing
Own
Rent
Property
Address and Property Details
Current home address
New home address
Current home insurance company
Expected closing date
Loan amount
Lender or mortgage company
Loan officer or closing contact
Closing contact email
Occupancy
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Primary home
Secondary home
Investment or rental
Anything the lender has requested
Home
Home Details
Approximate roof age
Approximate furnace age
Year built
Type of heat
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Gas
Oil
Electric
Propane
Other
Oil tank location
Home insurance claims in the last 5 years
No
Yes
Claim details
Property features
Wood stove
Pellet stove
Pool
Dogs
Bite history
Finished basement
Dog details, if any
Pool details, if any
Recent updates or notes
Bundle
Auto Bundle Review
Would you like us to check auto too?
Yes
No
Vehicles
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Drivers
Add driver
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Review and Send
Submit to Empire
Send Update to Empire
Vehicle
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Year, make, model
VIN
Ownership
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Owned
Financed
Leased
Current coverage, if known
Driver
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Full name
Date of birth
Driver license number
Accidents or tickets
