Vacant Propety Insurance Quote

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Vacant Property Insurance Quote

Name*

First Last

What type of entity owns the property?*

Full Legal Business Name, Estate or DBA if any*

Email*

Contact Phone Number*

Alt Phone Number (cell, home)

Mailing Address*

This is your mailing address, not necessarily the location address.

Street Address Address Line 2 City State ZIP Code

General Information

Your Occupation*

FYI - Self-Employed is not an occupation, that's an employer, we need to know what you do.

Date of Birth*

MM slash DD slash YYYY

Date of purchase of this property*

MM slash DD slash YYYY

Co-Insured if any

Is there an co-applicant or another insured that needs to be listed on this coverage?*

Yes

Co-Insured Name*

First Last

Co-Insured Date of birth

MM slash DD slash YYYY

Co-Insured Occupation

Relationship to Insured*

Property Information

Location Address of the Property*

Street Address Address Line 2 City State ZIP Code

What is the disposition of the home?*

Just Vacant

Vacant For Sale

Vacant Under an Existing Renovation

Vacant Pending an Upcoming Renovation

Estate Property - Owners Passed

Occupants were just evicted

Year Built*

Construction*

Exterior Covering*

# Of Stories

Roof Type*

Occupancy*

Total square feet of living space*

Garage, if any*

Hear Source*

Coal

Gas

Oil - Underground Tank

Oil - Above ground Tank

Oil - Basement Tank

Solar

Wood Burning

When did you purchase the property?*

Date Vacated*

Enter date purchased if purchased vacant and you are not immediately occupying the property

MM slash DD slash YYYY

Home Updates

This is VERY important! If no updates, enter the year of construction

Roofing Updates*

Partial

Complete

None

If updated, what year?*

Electrical System Updates*

Partial

Complete

None

If updated, what year?*

Circuit protection*

Circuit Breakers

Fuses

Both

Heating System Updates*

Partial

Complete

None

If updated, what year?*

Plumbing System Updates*

Partial

Complete

None

If updated, what year?*

Protective Devices, Safety & Security

Burglar Alarm*

Fire Alarm*

Smoke Alarm*

Temperature Alarm*

Pool Information*

Fences apply to the pool, not the yard.

Does the pool have a slide*

Yes

Does the pool have a diving board*

Yes

Which utilities are on*

Heat

Water

Gas

Loss / Claim Information

Any claims in the last 5 years*

Yes

Claim Details

If you have had any claims in the last 5 years, please provide the date, the cause of the loss, and the amount paid out for each one.

Current Insurance Information

Is the structure currently insured?*

Yes

It was, but it cancelled.

Current or Prior Insurance Co*

Most recent policy expiration or cancel date*

MM slash DD slash YYYY

Current or Prior Policy ANNUAL Premium*

Coverage Information

Dwelling Coverage*

This is the cost need to rebuild the dwelling, not the mortgage amount or fair market value.

Personal Property Coverage

The cost to replace your personal property inside of the dwelling.

Other Structures Coverage

The cost re replace or rebuild any detached garage or structures on the property.

Is there a present or planned renovation?*

Yes

Who is doing the renovations*

Property Owner

Uninsured Contractor

An Insured Contracting Conpany

What date are the renovatons to start or when did they start*

MM slash DD slash YYYY

Provide a detailed description of the renovations taking place or to take place.*

What is the total cost of the renovation?

Renovation Coverage*

What is the total cost of the renovations to take place.

Deductible Requested*

Liability Coverage*

This provides coverage for damage or injury stemming from this property.

How long do you need this coverage for?*

Optional Coverages*

NONE

Vandalism & Malicious Mischief Coverage

Special Form Coverage

Mechanical Breakdown Coverage

Finance Information

Ever filed Bankruptcy or Reorganization*

Yes

Has coverage been Declined, canceled or non-renewed in last 5 years*

Yes

If so, why?

Final Details

Finally, right?

soon do you need this quote*

YESTERDAY!

Immediately for a closing

Within 24 hours

24-48 hours

Within a week

When you get to it, I'm shopping

See date below

Before my term paper is due

Date quote needed by

MM slash DD slash YYYY

What date do you need this COVERAGE by*

MM slash DD slash YYYY

How did you hear about us?*

If referred, who are we thanking with a nice gift

Other things I want to tell you that you didn't ask.

Additional comments, concerns, circumstances, or coverages you have or want so share with us.

Name

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