INSURANCE ORDER FORM
Use this form to order property insurance. Once form is complete the insurance provider will reach out with paperwork and payment instructions. All policies are Actual Cash Value Policies.
INVESTOR NAME:
*
First Name
Last Name
INVESTOR EMAIL:
*
example@example.com
INVESTOR PHONE #:
*
-
Area Code
Phone Number
NAME ON TITLE:
*
Can be Individual, Corp or LLC.
MAILING ADDRESS (For entity or individual on title):
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
DATE OF BIRTH OF INVESTOR ON TITLE (NEEDED BY INSURANCE CO.):
*
-
Month
-
Day
Year
Date
INVESTMENT PROPERTY ADDRESS:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
TYPE OF INVESTMENT PROPERTY:
*
Multifamily
Commercial - Single Tenant
Commercial - Multiple Tenants
Industrial
Select Type Of Property.
Number Of Units/Suites:
*
PURCHASE PRICE:
*
REHAB EST:
*
APPROX SQ FT:
*
YEAR BUILT:
*
ROOF CONDITION:
*
NEWER.
AVERAGE.
POOR.
CLOSING DATE:
*
-
Month
-
Day
Year
Date
DESIRED DEDUCTIBLE (HIGHER DEDUCTIBLE = LOWER RATE):
*
$1,000
$2,500
$5,000
$10,000
SIGNATURE:
Submit
Should be Empty: