Tenant Insurance Quote Request

Tenant's Insurance Quote Request

for a Primary Residence, tenant occupied
Name of Insured person:

First NameMiddle InitialLast NameSuffix
Phone Number

Area CodePhone Number
Email (if no email, please enter "None"
example@example.com
Your date of birth

MonthDayYear
Date
Gender:
Marital/Civil Status:

Other
Occupation:
If none, write "Unemployed", "Disabled", or "Retired"
Is there a 2nd name on the Lease? (would need to be named on the policy)
Named Insured #2

First NameMiddle InitialLast NameSuffix
Relationship to first Insured:

Other
Email (Insured #2)
example@example.com
Date of Birth (Insured #2)

MonthDayYear
Date
Location to be covered:

Street Address

Street Address Line 2

CityState

Zip Code
How long have you lived at this location?
Effective Date you want:

MonthDayYear
Date
How many units/apartments are in the entire building?
Prior Address if under two years ago:

Street Address

Street Address Line 2

CityState

Zip Code
Will you be moving into the apartment on the effective date?
When do you plan to move into the house?
Do you currently have insurance on this Location?
When did your most recent policy cancel?
Is your current insurance company Cancelling or Non-renewing your policy?
Why is your current company cancelling your policy?
What total amount of coverage do you want for your personal property?
Furniture, appliances, rugs, clothing, etc.
Style of Building
Construction of building
Foundation Type
Garage?
Type of Heat
Location of oil tank
Do you have any dogs?
Describe Breed for each dog (please do not write "mutt" or only "mixed")
Has the dog had any bite history?
Is there a Swimming Pool (not if apartment complex)?
What type of pool?
Does the pool have a Diving Board or a Slide (check all that apply):
Is the pool gate locked?
Is there a Fire Hydrant within 1000 feet?
When was the Roof updated?
When was the Furnace updated/replaced?
Has the Plumbing and Wiring been updated within the past 25 years?
Please provide more detail why plumbing and wiring have not been updated:
Is there a Woodstove in the apartment?
Do you have any Business conducted in or on the Property?
Describe the Business conducted on the Property
Jewelry, Antiques, Collections, and Fine Arts have limitations on the basic policy. Do you have any items of this type?
Please describe the item(s) and the Value of each?
example: Ladies diamond ring, value $3,000
Any comments or special requests?
If no, please leave blank
How would you like us to contact you? (you can check more than one)
Name of person completing this form

First NameLast Name
How did you find us?
Were you referred to us by someone? If so, please let us know who referred you so we can send them a thank you.
Do you want this quote request sent to a particular person?
If you would like to upload a copy of your current Homeowners insurance policy, please use this:

Cancelof
Should be Empty:

Tenant's Insurance Quote Request