Rental Property Intake Form

Rental Property Intake Form

Please complete to the best of your ability. If you have any questions, please text/call me at 773-500-2727 or email me at sam@roseinsgroup.com
Submission Date

MonthDayYear
Date
Desired Start Date for the Insurance/Closing Date

MonthDayYear
Date
Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Name of the Business/Association Who Controls the Insurance
If you are a home or condo association, put the association's name. If the building is under an LLC, put the name of the LLC. If neither of these are true, fill out the names of the owners of the building.
Full Name of Owner

First NameLast Name
Date of Birth of Owner

MonthDayYear
Date
Location Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address - If Different From Location Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tax ID
If Applicable
Detailed Description of Business
Tell us about the property! Please detail how many buildings will be included and how many units are in each building. For the units, state how many are rented or owner occupied (in the case of an Association). Please state if any units are vacant and how long they have been vacant/when they are expected to be occupied. The more we know about it, the more we can share with underwriters who want your business!
Type of Ownership

Property Details
Square Footage of the Building Including Common Areas
If you aren't sure, you can get an estimate by adding up the square footage of each unit
Building Updates

*If you aren't sure, please provide your best estimate or any details on its condition/updates in the Additional Details section below*
The Roof was replaced inYear Roof Replaced*
The Electrical System was replaced inYear Electrical System was Replaced*
The HVAC was replaced inYear HVAC was Replaced*
The Plumbing System was replaced inYear Plumbing System was Replaced*
Are Grills Allowed on Balconies or within 10 Feet of the Building?
When Contractors Are Needed for Repairs/Maintenance, Do You Make Sure They Are Licensed and Insured and Keep a Copy of Their Insurance?
Any Renovations Planned? If So, Describe in Detail the Work Being Completed and the Timeline for Completion

Current Insurance Carrier
Put NA, if this is a new venture!
Current Premium
Sharing your current premium (monthly or yearly) helps us evaluate your coverage and identify potential savings or better options. We will tell you if you are getting a great deal!
Upload a Copy of Your Current Policy or Any Other Necessary Documents

Cancelof
Provide Any Other Details You Believe Would Be Helpful
We want to make sure we find you the coverage you want. Feel free to take this space to let us know what you are looking for in an insurance company. We will do our best to find it for you!
Should be Empty:

Property Details