High Rise

High Rise
Luxury Apartment Homes
Name*

First NameLast Name
Liability amount
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Who referred you to us?*
List the name of your Realtor, the HOA, or Lender who sent you our way
Community/Building Name
Date of Birth*

MonthDayYear
Second Named Insured

First NameLast Name
Date of Birth for second named insured

MonthDayYear
Is this a Lease or a Purchase?*

LeasePurchase

Lease
Lease start date*

MonthDayYear
Date
Legal names of each person on the lease*
List each person's Legal Name listed on the Lease
Phone numbers for each person on the lease*
Enter each person's cell phone number
Emails for each person on the lease*
Enter each person's email address. In case of claims this is used for identity verification
Property address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Residence Occupancy Type*
Primary Residence, Seasonal, AirBnB, For Rent Long Term

Purchase
Purchase Date*

MonthDayYear
Date
Legal Name of each person on the title*
List each person's Legal Name listed on the title
Phone number for each person on the title?*
Enter each person's cell phone number
Email for each person on the title*
Enter each person's email address. In case of claims this is used for identity verification
Unit Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Approximate sq footage of your unit*
List square footage or number of bedrooms
Occupancy Type*
Primary Residence, Seasonal, AirBnB, For Rent Long Term

You are not required to pay for services or utilize our office to secure insurance services in exchange for obtaining your insurance policy. While you have chosen to collaborate with Majdas Touch Insurance, Inc., you are under no obligation to do so, and you retain the freedom to explore other brokerages without incurring any fees. The decision to continue paying this fee is entirely voluntary, and you are making it of your own accord and volition.
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Luxury Apartment Homes