LANDLORD 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
Insured Company Initiated Cancel
Customer Requested Cancel
Other
State the Reason
*
Additional Comment in your Insurance Situation:
How did you hear about us?
*
Google
Website
Print Ad
LeTip
Tagged in Facebook Group
Instagram
LinkedIn
Networking
Referred
Other
Who referred you to us?
*
Please input their name here.
Back
Next
Save
Insured's Information
Please fill out all the required information below so we can provide you more accurate quote.
Name of deed on Property
Individual, Corporation, LLC. Trust
Address of Property to be Insured:
*
Street Address
City
State / Province
Postal / Zip Code
Mailing Address
*
Street Address
City
State / Province
Postal / Zip Code
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
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
19
20
21
22
23
24
25
26
27
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
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
SSN
Social Security Number
Are there additional people that needs to be listed as Insured?
*
Please Select
Yes
No
Additional Insured Information
Please input the information of the Additional Insured.
Additional Insured's Name
*
First Name
Last Name
Additional Insured's 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
19
20
21
22
23
24
25
26
27
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
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
SSN
Additional Insured's Social Security Number
Occupation
Additional Insured'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
Additional Insured's Education
Phone Number
Please enter a valid phone number.
Email
example@example.com
Back
Next
Save
Policy Information
Current Insurance
*
Please Select
Currently Insured
Lapsed
New Home Purchasing
What is the expected closing 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
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
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
*
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
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2027
2026
2025
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
Hurricane / CAT Deductible
*
Example: 1%, 2%, $5,000
Protection Class
Current Declaration Page
Browse Files
Drag and drop files here
Choose a file
Do you have a soft copy of your Current Declaration Page? Please upload it here.
Cancel
of
Back
Next
Save
Underwriting Information
Do you have a Trampoline
*
Please Select
Yes
No
Does it have a net?
*
Please Select
Yes
No
Do you have a Pool?
*
Please Select
Yes
No
Pool Location
*
Please Select
Inground
Above Ground
Does it have a slide?
*
Please Select
Yes
No
Does it have a diving board?
*
Please Select
Yes
No
How many feet or less from the water?
*
Please Select
2ft or less from the water
2ft or more
Is there a 4ft fence around the yard?
*
Please Select
Yes
No
Do you have a dog?
*
Please Select
Yes
No
How many?
*
How many dogs do you have?
Dog Breeds?
*
Biting History
Please list date of loss and describe the claim.
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
Do you have a water device detection?
*
Please Select
Yes
No
Back
Next
Save
Property Information
Year of Purchase Date (You moved in the Property)
*
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
19
20
21
22
23
24
25
26
27
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
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
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 Families
*
Beds
*
How many bedrooms do you have?
Stories
*
Example: 1 story; 2 stories.
Bath
*
How many bathrooms do you have?
Foundation Type
*
Please Select
Slab
Crawl Space
Basement Unfinished
Basement Partial Finish
Basement Fully Finished
Pier and Beam
Garage
*
Please Select
Attached Garage, 3 Car
Attached Garage, 2 Car
Attached Garage, 1 Car
Attached Garage, SF
Detached Garage, 2 Car
Detached Garage, 1 Car
Built-in Garage, 2 Car
Built-in Garage, 1 Car
Carport, 2 Car
Carport, 1 Car
None
Are there any apartments or secondary living areas of the home?
*
Please Select
Yes
No
If yes, are they permitted with the town?
*
Please Select
Yes
No
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
Ranch
Colonial
Split-level
Duplex
Apartment - Condo Building
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
None
Please Specify
*
How many Sheds?
*
Do you have a solar panel?
*
Please Select
Yes
No
Panel Ownership
*
Please Select
Leased
Owned
Financed
Number of Panels
*
Total Value
*
Total value of all the solar panels you have.
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?
*
For example: outdoor above ground, outdoor below ground, indoor on masonry floor, indoor not on masonry floor.
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.
Back
Next
Save
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
Back
Next
Save
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?
Save
Submit
Should be Empty: