FAST AND EASY RENTAL PROPERTY INSURANCE PROPOSAL FOR BUSY PEOPLE

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FIRST NAMEFirst Name

LAST NAME

Dateof appointment

Mailing Address

Unit #your full name

Cityyour city

STATE

CA

ZIPZIP

PHONECELL PHONE#

Emaila valid email

Email again for Accuracya valid email

Married ?

YesNo

Birthdate of OwnerBirth driver 2

Currently Insured ?

YesNo

Current Insurance Company name ?your full name

What is your Occupation? (Also list your spouses occupation if married.)

Dwelling Information

Property Address

Cityyour city

STATE

CA

ZIPZIP

Countyyour county

Property Type

Property TypeSingle Family Home2 Unit Building3 Unit Building4 Unit Building

Year Built

Square Foot Est.

Fully Built

Property Fully Built ?YesNo

If Not Fully Built... Mth / Yr to be completed and details?your full name

Foundation

Foundation Type ?SlabCrawlspaceBasementOther

Garage

Garage Type ?AttachedDetachedCarportNone

Construction

Construction Type ?FrameBrick/VeneerStoneOther

Stories

# of Stories ?1 Story1.5 Story2 Story3 Story

Baths

# Baths?1 1.5 22.5 344.555.566.577.58

Roof Type

Roof Type ?ShingleWood ShakeTar/GravelRockSpanish TileMetalOther

Plumbing Type ?pick one!

Plumbing Type ?CopperGalvanizedMixedOther

Heat Type

Select HeatingGasElectricCoalWood BurningOther

Circuit Breakers ?

Circuit Breakers ?Circuit BreakersFuses

Claims Last 3 years?

YesNo

Describe all claims & amounts last 3 years?

Brush Area ?

YesNo

Describe any brush or fire hazard.your full name

Pool ?

YesNo

Jacuzzi ?

YesNo

PLEASE DESCRIBE IN DETAIL ANY SPECIAL FEATURES, ADDITIONS, OR MODIFICATIONS TO THE PROPERTY.more details

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DESCRIBE ANY SPECIAL COVERAGE REQUESTS SUCH AS HIGH LIABILITY LIMITS, HIGHER DWELLING COVERAGE, etc. LIST THEM HERE. If there is no additional coverage requests or exposures type "NONE"more details

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