Vacant Building Insurance Quote Vacant Property Insurance Quote "*" indicates required fields Step 1 of 4 25% Vacant Property Insurance QuoteName* First Last What type of entity owns the property?*CorporationDBAEstateIndividual - Sole ProprietorJoint VentureLLCNot-For Profit OrganizationPartnership - BusinessPartnership - SpousesSub Chapter "S" CorpFull 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code General InformationYour 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 anyIs there an co-applicant or another insured that needs to be listed on this coverage?* No Yes Co-Insured Name* First Last Co-Insured Date of birth MM slash DD slash YYYY Co-Insured OccupationRelationship to Insured*SpouseParentChildBusiness PartnerOtherProperty InformationLocation Address of the Property* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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*Frame (wood)Masonry (Concrete, brick, or block)Joisted Masonry (Frame with wood floors)Masonry Veneer (Frame with masonry exterior)MetalExterior Covering*AluminumAsbestos shinglesBrickEFISCedarClapboardStuccoVinyl# Of Stories1 (ranch)1-1/222-1/2345More than 5Roof Type*Asphalt ShinglesArchitectural ShinglesCompositionMetalRubberTar & GravelTerra CottaWood ShakesOccupancy*Apartment Unit1 Family2 Family3 Family4 FamilyCondo UnitCoop UnitTotal square feet of living space*Garage, if any*None1 Car Attached2 Car Attached3 Car Attached1 Car Built in2 Car Built in3 Car Built in1 Car Detached2 Car Detached3 Car DetachedCar PortHear 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 UpdatesThis is VERY important! If no updates, enter the year of constructionRoofing 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 & SecurityBurglar Alarm*NoneLocal Alarm SystemCentral Station Monitored AlarmFire Alarm*NoneLocal Alarm SystemCentral Station Monitored AlarmSmoke Alarm*NoneLocal Alarm SystemCentral Station Monitored AlarmTemperature Alarm*NoneLocal Alarm SystemCentral Station Monitored AlarmPool Information*Fences apply to the pool, not the yard.No PoolAbove Ground Pool with a FenceAbove Ground Pool with no FenceIn Ground Pool with a FenceIn Ground Pool with no FenceDoes the pool have a slide* Yes No Does the pool have a diving board* Yes No Which utilities are on* Heat Water Gas Loss / Claim InformationAny claims in the last 5 years* Yes No Claim DetailsIf 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 InformationIs the structure currently insured?* Yes No 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 InformationDwelling Coverage*This is the cost need to rebuild the dwelling, not the mortgage amount or fair market value.Personal Property CoverageThe cost to replace your personal property inside of the dwelling.Other Structures CoverageThe cost re replace or rebuild any detached garage or structures on the property.Is there a present or planned renovation?* No 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*$500$1,000$2,500$5,000$10,000Liability Coverage*This provides coverage for damage or injury stemming from this property.None$100,000$200,000$300,000$500,000$1,000,000How long do you need this coverage for?*3 Months6 Months9 Months12 MonthsOptional Coverages* NONE Vandalism & Malicious Mischief Coverage Special Form Coverage Mechanical Breakdown Coverage Finance InformationEver filed Bankruptcy or Reorganization* Yes No Has coverage been Declined, canceled or non-renewed in last 5 years* Yes No If so, why?Final DetailsFinally, 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?*SelectAOLGoogleYahooAn article I readRadio or TV InterviewYou already insured something of mineI was referred by someoneNo freaking clueIf referred, who are we thanking with a nice giftOther 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.EmailThis field is for validation purposes and should be left unchanged.
