CONDO POLICY INFORMATION
Contact Information
Please put your full name and contact information below:
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Is it OK to text this number?
*
Please Select
Yes
No
We promise not to share this information to others no spam you.
Email
*
example@example.com
Reason for Shopping
*
Please Select
New Home Purchase
Lower Premium
Cancelled Prior Insurance
How did you hear about us?
*
Google
Website
Print Ad
LeTip
Tagged in Facebook Group
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LinkedIn
Networking
Referred
Other
Who referred you to us?
*
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Insured's Information
Please fill out all the required information below so we can provide you more accurate quote.
Address of Property to be Insured:
*
Street Address
City
State / Province
Postal / Zip Code
Mailing Address is the same as Property?
Please Select
Yes
No
Mailing Address
*
Prior Address if less than 3 years:
If none, skip.
Occupation
*
Education
Please Select
Currently in School
No High School Diploma
High School Diploma
Some College - No Degree
Vocational/Technical Degree
Associate Degree
Bachelors
Masters
Phd
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Law Degree
Birth date
*
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1922
1921
1920
Year
SSN
Social Security Number
Marital Status
*
Please Select
Single
Married
Domestic Partner
Widowed
Separated
Divorced
Spouse's Information
Please input the information of your Spouse.
Spouse's Name
First Name
Last Name
Spouse's Birth date
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Month
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31
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1924
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1922
1921
1920
Year
SSN
Spouse's Social Security Number
Occupation
Spouse's Occupation
Education
Please Select
Currently in School
No High School Diploma
High School Diploma
Some College - No Degree
Vocational/Technical Degree
Associate Degree
Bachelors
Masters
Phd
Medical Degree
Law Degree
Spouse's Education
Phone Number
Please enter a valid phone number.
Email
example@example.com
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Policy Information
Current Insurance
*
Please Select
Currently Insured
Lapsed
New Home Purchasing
What is the expected closing date?
*
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Month
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Day
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2027
2026
2025
2024
Year
How long ago did you lapsed?
*
What Carrier
*
Current Carrier
*
For how long in Current Carrier?
*
Please put the number of years or months you've been in that carrier. Example: 2 years; 6 months.
Expiration of Policy
*
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January
February
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May
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Month
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Day
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2027
2026
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2024
Year
Do you have active Renters or Homeowners Insurance at this prior address?
*
Please Select
Yes
No
Will the home be vacant?
*
Please Select
Yes, less than 30 days
Yes, more than 30 days
No, Moving in right away
What are your Current liability limits?
*
Please Select
$100 000
$300 000
$500 000
$1 000 000
I don't know
For how long?
*
Please put the estimated days for how long it will be vacant?
Price you are currently paying
Indicate per month or per year
Mortgage Information
If you have a Mortgage, please input your Mortgage information here.
Building Limit
*
Content Coverage Limit
*
Personal Liability
Please Select
$300,000
$500,000
$1,000,000
Medical Payment
Please Select
$1,000
$5,000
$10,000
Policy Deductible
*
Example: 1%, 2%, $5,000
Current Declaration Page
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Underwriting Information
Do you have a dog?
*
Please Select
Yes
No
How many?
*
How many dogs do you have?
Dog Breeds?
*
Biting History
Do you have a burglar alarm?
*
Please Select
Yes
No
Is it central or local?
*
Please Select
Central
Local
Burglar Alarm
Do you have a fire alarm?
*
Please Select
Yes
No
Is it central or local?
*
Please Select
Central
Local
Fire Alarm
Check all that apply:
Sprinklers in your unit
Gated Community
Locked Building
Other
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Property Information
Year of Purchase Date (You moved in the Property)
*
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May
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31
Day
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1925
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1922
1921
1920
Year
Year Built
*
Occupancy of Home
*
Please Select
Primary
Seasonal
Secondary
Tenant Occupied
How many months is the home vacant throughout the year?
*
Square Feet
*
Number of units in your building
*
Beds
*
How many bedrooms do you have?
Bath
*
How many bathrooms do you have?
Will the home be used for any AirBnb or have any business ran from the home or employees coming or going?
*
Please Select
Yes
No
Please Explain
*
Year Roof Update
*
Roof Shape
Please Select
Gable
Hip
Flat
Roof Material
*
Please Select
Architectural Shingles
Asphalt Shingles
Metal
Clay Tile
Concrete Tile
Home Construction Type
*
Please Select
Frame
Non-Combustible
Masonry
Stucco
Home Style
*
Please Select
Apartment - Condo Building
Duplex
Rowhouse - Townhouse Style
Siding Type
*
Vinyl Siding
Aluminum Siding
Cedar Shake
Stucco
Brick (Solid)
Stone Veneer
Cement/Asbestos
Hardboard
Other
Patio
*
Please Select
Yes
No
Size
*
Porch
*
Please Select
Yes
No
Size
*
Deck
*
Please Select
Yes
No
Size
*
Patio or Porch?
*
Please Select
None
Open Porch
Enclosed Porch
Wood Deck
Screened Porch
Patio Cover
Redwood Deck
Composite Deck
More
Sheds or other Structure?
*
Please Select
Sheds
Other Structure
Please Specify
*
How many Sheds?
*
Water Heater Update
*
Please Select
No Update since Original Year Built
Partial Update
Complete Update
Year Updated
*
Enter the Year Updated of the property.
Heating Update
*
Please Select
No Update since Original Year Built
Partial Update
Complete Update
Year Updated
*
Enter the Year Updated of the property.
Heating Type
*
Please Select
Gas
Oil
Electric
Other
Where is the tank located?
*
Electrical Update
*
Please Select
No Update since Original Year Built
Partial Update
Complete Update
Year Updated
*
Enter the Year Updated of the property.
Plumbing Update
*
Please Select
No Update since Original Year Built
Partial Update
Complete Update
Year Updated
*
Enter the Year Updated of the property.
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Coverage Information
Select Optional Coverages:
Personal Injury
Additional Dwelling Coverage
Equipment Breakdown
Identity Theft
Replacement Cost Content
Water Back-up
Service Line
Scheduled Personal Property
Other
Enter Amount
Please enter the amount of the Coverages you selected:
Additional Dwelling Coverage
Identity Theft
Equipment Breakdown
Water Back-up
Service Line
Scheduled Personal Property
Example: 1 Diamond Earrings $15,000
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More about your Property
Please note anything about your Property.
Is there anything about your property that stands out or is unique that we did not ask?
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BUNDLE YOUR CONDO AND AUTO
One of the main benefits of bundling is that companies often offer discounts if you hold several policies with them, so it can save you money. In fact, most carriers will automatically add a multiple-policy discount on both policies, allowing you to save money on your total cost of insurance.
Do you want to bundle you condo and auto?
*
Please Select
Yes
No
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AUTO POLICY INFORMATION
Do you have current Insurance?
*
Please Select
Yes
No
Do you have insurance in the past?
*
Please Select
Yes
No, First Time
Reason for Shopping
*
Please Select
Price
Being Dropped from Current Company
Other
Please Explain:
*
When are you being dropped?
*
Please Select
Yes
No
Why are you being dropped?
*
Please Select
Yes
No
How long ago did you lapsed?
*
What Carrier
*
Current Carrier
*
For how long in Current Carrier?
*
Please put the number of years or months you've been in that carrier. Example: 2 years; 6 months.
Expiration of Policy
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
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1
2
3
4
5
6
7
8
9
10
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28
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30
31
Day
Please select a year
2027
2026
2025
2024
Year
Preferred Payment Plan
*
Please Select
Monthly
Annually
DRIVERS
Your Driver's License
Primary Driver's License
Your State
Primary Driver's License State
Student: Check all that apply
GPA of 3.0/B or higher
Away at School > 75 miles
Living at Home - Commuting to School
Driver Training Course Completed
Other
What was defensive driving taken within the past 3 years?
Please list all tickets and accident in the past 5 years
Please be detail as possible, date, details and injuries.
Driver's License
*
Spouse's Driver's License
State
*
Spouse's Driver's License State
Student: Check all that apply
GPA of 3.0/B or higher
Away at School > 75 miles
Living at Home - Commuting to School
Driver Training Course Completed
Other
What was defensive driving taken within the past 3 years?
*
Please list all tickets and accident in the past 5 years
*
Please be detail as possible, date, details and injuries.
ADDITIONAL HOUSEHOLD MEMBERS
How many additional household members?
Please list all additional household members other than yourself over the age of 14.
*
Please Select
None
1
2
3
4
ADDITIONAL MEMBER 1 INFORMATION
Name (Driver 1)
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
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1
2
3
4
5
6
7
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12
13
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20
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27
28
29
30
31
Day
Please select a year
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2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
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2003
2002
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2000
1999
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1991
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1986
1985
1984
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1925
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1922
1921
1920
Year
Driver's Status
*
Please Select
Licensed
Unlicensed
Permit
What was defensive driving taken within the past 3 years?
*
Driver's License
*
State
*
Relationship
*
Please Select
Child
Domestic Partner
Employee
Parent
Relative
Spouse
Other
Occupation
*
Education
*
Please Select
Currently in School
No High School Diploma
High School Diploma
Some College - No Degree
Vocational/Technical Degree
Associate Degree
Bachelors
Masters
Phd
Medical Degree
Law Degree
Student: Check all that apply
*
GPA of 3.0/B or higher
Away at School > 75 miles
Living at Home - Commuting to School
Driver Training Course Completed
Other
Please list all tickets and accident in the past 5 years
*
Please be detail as possible, date, details and injuries.
Please upload their Driver's License for additional drivers.
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ADDITIONAL MEMBER 2 INFORMATION
Name (Driver 2)
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
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31
Day
Please select a year
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2023
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2021
2020
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2018
2017
2016
2015
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2013
2012
2011
2010
2009
2008
2007
2006
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1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Driver's Status
*
Please Select
Licensed
Unlicensed
Permit
What was defensive driving taken within the past 3 years?
*
Driver's License
*
State
*
Relationship
*
Please Select
Child
Domestic Partner
Employee
Parent
Relative
Spouse
Other
Occupation
*
Education
*
Please Select
Currently in School
No High School Diploma
High School Diploma
Some College - No Degree
Vocational/Technical Degree
Associate Degree
Bachelors
Masters
Phd
Medical Degree
Law Degree
Student: Check all that apply
*
GPA of 3.0/B or higher
Away at School > 75 miles
Living at Home - Commuting to School
Driver Training Course Completed
Other
Please list all tickets and accident in the past 5 years
*
Please be detail as possible, date, details and injuries.
Please upload their Driver's License for additional drivers.
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ADDITIONAL MEMBER 3 INFORMATION
Name (Driver 3)
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
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13
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15
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28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
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1999
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1997
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1991
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1984
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1982
1981
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1979
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1966
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1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Driver's Status
*
Please Select
Licensed
Unlicensed
Permit
What was defensive driving taken within the past 3 years?
*
Driver's License
*
State
*
Relationship
*
Please Select
Child
Domestic Partner
Employee
Parent
Relative
Spouse
Other
Occupation
*
Education
*
Please Select
Currently in School
No High School Diploma
High School Diploma
Some College - No Degree
Vocational/Technical Degree
Associate Degree
Bachelors
Masters
Phd
Medical Degree
Law Degree
Student: Check all that apply
*
GPA of 3.0/B or higher
Away at School > 75 miles
Living at Home - Commuting to School
Driver Training Course Completed
Other
Please list all tickets and accident in the past 5 years
*
Please be detail as possible, date, details and injuries.
Please upload their Driver's License for additional drivers.
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ADDITIONAL MEMBER 4 INFORMATION
Name (Driver 4)
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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20
21
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28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
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1963
1962
1961
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Driver's Status
*
Please Select
Licensed
Unlicensed
Permit
What was defensive driving taken within the past 3 years?
*
Driver's License
*
State
*
Relationship
*
Please Select
Child
Domestic Partner
Employee
Parent
Relative
Spouse
Other
Occupation
*
Education
*
Please Select
Currently in School
No High School Diploma
High School Diploma
Some College - No Degree
Vocational/Technical Degree
Associate Degree
Bachelors
Masters
Phd
Medical Degree
Law Degree
Student: Check all that apply
*
GPA of 3.0/B or higher
Away at School > 75 miles
Living at Home - Commuting to School
Driver Training Course Completed
Other
Please list all tickets and accident in the past 5 years
*
Please be detail as possible, date, details and injuries.
Please upload their Driver's License for additional drivers.
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Vehicle Information
Please be sure to double check everything before moving to the next page.
Classic Car
Do you have a Classic Car?
*
Please Select
Yes
No
Please input Year Make & Model | VIN Number | and Estimated Value:
*
Example: Ferrari 250 GTO 1962, 132456ABCDEF, $40 million
Classic Car Declaration Page
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Personal Auto
How many Vehicles other than the Classic Car do you want to be insured?
*
Please Select
0
1
2
3
4
5
VEHICLE 1
VIN Number
*
Year Make & Model
*
Ownership Type
*
Please Select
Finance
Leased
Owned
Usage
*
Please Select
Pleasure
Business Use
Commuting to Work / School
How many miles one way?
*
Odometer
Annual Mileage
*
Comprehensive Deductible
*
Please Select
No Coverage
100
250
500
1000
Greater 1000
Rental
*
Please Select
Yes
No
Collision Deductible
*
Please Select
No Coverage
100
250
500
1000
Greater 1000
Full Glass Coverage
*
Please Select
Yes
No
Roadside
*
Please Select
Yes
No
Towing
*
Please Select
Yes
No
VEHICLE 2
VIN Number
*
Year Make & Model
*
Ownership Type
*
Please Select
Finance
Leased
Owned
Usage
*
Please Select
Pleasure
Business Use
Commuting to Work / School
How many miles one way?
*
Odometer
Annual Mileage
*
Comprehensive Deductible
*
Please Select
No Coverage
100
250
500
1000
Greater 1000
Rental
*
Please Select
Yes
No
Collision Deductible
*
Please Select
No Coverage
100
250
500
1000
Greater 1000
Full Glass Coverage
*
Please Select
Yes
No
Roadside
*
Please Select
Yes
No
Towing
*
Please Select
Yes
No
VEHICLE 3
VIN Number
*
Year Make & Model
*
Ownership Type
*
Please Select
Finance
Leased
Owned
Usage
*
Please Select
Pleasure
Business Use
Commuting to Work / School
How many miles one way?
*
Odometer
Annual Mileage
*
Comprehensive Deductible
*
Please Select
No Coverage
100
250
500
1000
Greater 1000
Rental
*
Please Select
Yes
No
Collision Deductible
*
Please Select
No Coverage
100
250
500
1000
Greater 1000
Full Glass Coverage
*
Please Select
Yes
No
Roadside
*
Please Select
Yes
No
Towing
*
Please Select
Yes
No
VEHICLE 4
VIN Number
*
Year Make & Model
*
Ownership Type
*
Please Select
Finance
Leased
Owned
Usage
*
Please Select
Pleasure
Business Use
Commuting to Work / School
How many miles one way?
*
Odometer
Annual Mileage
*
Comprehensive Deductible
*
Please Select
No Coverage
100
250
500
1000
Greater 1000
Rental
*
Please Select
Yes
No
Collision Deductible
*
Please Select
No Coverage
100
250
500
1000
Greater 1000
Full Glass Coverage
*
Please Select
Yes
No
Roadside
*
Please Select
Yes
No
Towing
*
Please Select
Yes
No
VEHICLE 5
VIN Number
*
Year Make & Model
*
Ownership Type
*
Please Select
Finance
Leased
Owned
Usage
*
Please Select
Pleasure
Business Use
Commuting to Work / School
How many miles one way?
*
Odometer
Annual Mileage
*
Comprehensive Deductible
*
Please Select
No Coverage
100
250
500
1000
Greater 1000
Rental
*
Please Select
Yes
No
Collision Deductible
*
Please Select
No Coverage
100
250
500
1000
Greater 1000
Full Glass Coverage
*
Please Select
Yes
No
Roadside
*
Please Select
Yes
No
Towing
*
Please Select
Yes
No
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Policy Coverages
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Bodily Injury / Property Damage
Personal Injury Protection (PIP)
Uninsured Motorist BI / PD
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