Location Addition Request

Location Addition Request
Who is your agent/account manager with iPROTECT?
Individual or Business Name that Property will be deeded to: (needs to read exactly as will be shown on deed)*
Your current policy number, if available, you'd like this location added to?
Date coverage needs to be effective?*

MonthDayYear
Date
We cannot guarantee the carrier will backdate coverage, in the event they will not the location will be added effective the date your request is received in our office.
Your Name*

First NameLast Name
Your email*
example@example.com
Your phone number*
Please enter a valid phone number.
Location to add*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Est. Original Year Built*
YYYY
Square Footage*
# of Units*
Any renovations expected?*
Monthly Rent
Age of Roof (In years - roofs over 15 years old will be adjusted at actual cash value)*
Year of most recent Plumbing Renovation*
YYYY
Is the electrical on circuit breakers?*
Does the property have a swimming pool? *
Any damage to the property?*
Section 8 or Subsidized Housing?*

YesNo
Have you had a loss on this property in the last 3 years?*
Do you have a mortgagee/lender that needs to be included?*
Include your mortgagee/Lender's full mortgagee clause with loan # if available:
Will you have a Fannie Mae/Freddie Mac loan?
Will the insurance premium payment be escrowed?
Include Sewer & Water Backup Coverage?*

YesNo
Include Ordinance or Law Coverage?*

YesNo
Additional comments/requests for this property:
**If there is a minimum required limit of insurance include that limit here, otherwise we will insure at $120/sq ft**
File Upload

You may upload any documents relevant to this location you wish for us to add here.
Cancelof
Should be Empty: