Renters Insurance Quote Request

First and Last Name of Proposed Policy Owner *
Street Address of Rental Property *
City  *
State  * (Must be California)
Zip Postal Code  *
Work Phone  
(eg. xxx-xxx-xxxx)
Home Phone  
(eg. xxx-xxx-xxxx)
E-mail address  *
Effective Date desired *

PROPERTY DESCRIPTION INFORMATION

 
$ Amount of personal property to be insured  *
Approximate Year Built   *
Approximate Living Space in Sq. Ft.   *
Type of Building Construction (Choose One)   *
Type of Roof (Choose One)   *
Approx. Number of Units or Families in Building   *
Do you have a wood burning stove ?  * YES    NO
Do you have any other type of renters insurance ? * YES    NO

UNDERWRITING QUESTIONS

 
Is the Dwelling occupied or will it be occupied within 10 days of inception of coverage ? * YES    NO
Will more than one family occupy the dwelling ? * YES    NO
Do you own any animals that will also occupy this dwelling? * YES    NO
If your answer is YES to the above, please provide the type and breed of the animal(s)
Is the dwelling within 500 ft. of native brush, or is it isolated or inaccessible to fire fighting equipment ? * 
Have you had any insurance losses in the last three (3) years? * YES    NO
If Yes to insurance losses above - please describe 

QUOTE REQUEST QUESTIONS

 
We can often save you as much as 25% additional savings by combining dwelling insurance with auto insurance. Would you have an interest in also receiving a quote on your auto insurance ? * YES    NO
How do you prefer to receive your insurance quote ? * Phone    E-mail
Insert comments or questions if any
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