Apartment Building Insurance Quote Form

Your Name:
Business Name:
Property Address:
City:
State: (Must be California)
Zip/Postal:
E-Mail (Required):
E-Mail
(again for accuracy):
Phone:
(eg. xxx-xxx-xxxx)
Fax (optional):

Dwelling Information
Year Building Built:
Building Square footage:
Gross Annual Rents: $
Occupancy: Owner Tenant
Occupancy Type:
(describe entities & and number of units, such as "12 unit apartment" or "2 apartments, 2 offices and barber shop", or "4 apartments over a restaurant", etc.)
Type foundation: Slab
Crawlspace over slab
Pier & Post
Other (list in remarks)
Type finished basement, if any: None Full
25% 50% 75%
Type Roof: Shingle Wood Shake
Tar/Gravel Spanish Tile Metal Other
Type of Siding Brick   Vinyl
Wood   Aluminum
Number of stories: One Two
Three 4 or more
# of feet to nearest fire hydrant: # of miles to nearest
fire station:
Currently Insured? Yes No
Name of Carrier & how long insured?
Prior Claims? Yes No
Describe claims in detail:
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)

Coverages:
Building Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
Other Coverage/Remarks
(describe any extra coverages needed such as business interruption, robbery, computers, etc.):
Send my quotation via: E-Mail Fax
Regular Mail
Call Me by Phone
Thank you for filling out this form COMPLETELY!

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