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Renters/Apartments/Condo Quote

No coverage is bound until you are contacted by one of our representatives

 CONTACT INFORMATION
 Name  
 Street Address  
 Street Address/Apt #  
 City, State, Zip  
 Social Security #  
 Date of birth  
 Occupation  
 Employer  
 Phone Number   Home    Work 
SPOUSE INFORMATION
 Social Security #  
 Date of birth  
 Occupation  
 Employer  
 Phone Number  Work 
 PROPERTY INFORMATION
 a. How many units in the complex  
 b. # Units/bldg  
 c. Is there a fire wall between units  
 d. Is there an Apartment or Condo Association?  
RATING INFORMATION
 1. What year was this dwelling built?
 2. What type of dwelling?
 3. What type of construction?
 4. Do you have a fireplace?
      If yes, please describe what type
 5. Do you have a woodstove?
 6. What is the primary source of heat?
 7. What is the secondary source of heat?
 8. Do you have a security system?
      If yes, please describe what type
 9. Have you had any losses in the past 3 years?
      If yes, please describe
 10. Do you have renters insurance now?
 11. Do you own any pets?
    If yes, Please describe 
COVERAGE INFORMATION
 1. What is the total value of your personal property? $
 2. Do you want earthquake coverage?
 3. Do you have collections worth over $500?
    If yes, Please describe 
 4. Do you have any single piece(s) of jewelry valued over $500?     
    If yes, Please describe 
 5. Do you have work tools that need coverage?
    If yes, Please describe 
 6. Do you operate a business out of your residence?
    If yes, Please describe 
ADDITIONAL INSURED
 Name  
 Address  
 Phone Number   Phone     FAX
 Account or Loan #  
 LIENHOLDER/MORTGAGE INFO
 Name  
 Address  
 Phone #  
 Fax #  
 Loan #  
 Legal Description  
 Building Owned or
 Leased		  
 Please use the space below to add comments regarding any special circumstances or coverage needs
 

 
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