“We’ll Do It For You”Sidney, NY Office1 Main StreetSidney, NY 13838-2009Phone: 607.287.4944General InformationName* First Last What type of insurance are you interested in?* Auto Home Mobile Home Motorcycle Snowmobile/ATV Fire Landlord Business OtherPhone*Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Preferred Method of Contact*choose onePhoneEmailWhen can we get back to you?*ImmediatelySame dayTomorrow is fineWhat brought you to inquire with Gates-Cole?Who referred you?Additional CommentsAuto InsuranceUpload a PDF of your current coverage Drop files here or Select filesMax. file size: 32 MB.Who is your current insurance company?Who is your current agent?How did you select your current coverage?OccupationVehicle YearVehicle MakeHave you had any accidents/claims? Yes NoHave you had any tickets/violations? Yes NoVehicle is for: Work PersonalAre you looking to change on renewal or just shopping around?Change on RenewalShopping AroundNumber of drivers in household?Homeowners InsuranceUpload a PDF of your current coverage Drop files here or Select filesMax. file size: 32 MB.Who is your current insurance company?Who is your current agent?How did you select your current coverage?Is this your primary, secondary, or seasonal residence? Primary Secondary SeasonalIs there any business conducted on the premises? Yes NoConstruction type? (Ex: Wood, Brick Masonry)Any other structures? (Ex: Garage, barn, shed)Year BuiltUpdates to electric, roof, plumbing, etc.? Yes NoYear of UpdateDo you have a fireplace, stove, or pellet stove? Yes NoSmoke-free home? Yes NoDo you own a swimming pool or trampoline? Yes NoDo you own a dog? Yes NoIf yes, what breed?Has your insurance ever been cancelled or non-renewed?Any losses in the last 5 years?Fire department that is on call for your house?Additional CommentsMotorcycle InsuranceUpload a PDF of your current coverage Drop files here or Select filesMax. file size: 32 MB.Who is your current insurance company?Who is your current agent?How did you select your current coverage?Snowmobile/ATV InsuranceUpload a PDF of your current coverage Drop files here or Select filesMax. file size: 32 MB.Who is your current insurance company?Who is your current agent?How did you select your current coverage?Fire InsuranceUpload a PDF of your current coverage Drop files here or Select filesMax. file size: 32 MB.Who is your current insurance company?Who is your current agent?How did you select your current coverage?Landlord InsuranceUpload a PDF of your current coverage Drop files here or Select filesMax. file size: 32 MB.Who is your current insurance company?Who is your current agent?How did you select your current coverage?Business InsuranceUpload a PDF of your current coverage Drop files here or Select filesMax. file size: 32 MB.Who is your current insurance company?Who is your current agent?How did you select your current coverage?OtherType of InsuranceUpload a PDF of your current coverage Drop files here or Select filesMax. file size: 32 MB.Who is your current insurance company?Who is your current agent?How did you select your current coverage?
