Rental Dwelling Quote

First Named Insured    DOB: //19

Second Named Insured      DOB: //19
 
Mailing Address: 
 
 City:                                           State:       Zip: 
                          
Phone: 
 
 Fax:     
 
 Email:  
 

Dwelling Fire Information

Location Address: 
 
 City:                                           State:       Zip: 
                        

Year Built: (ex. 2005)     Number of Units:     Number of Families:

Construction Type:

Square Foot:                      Occupancy:

Year Updated:     Roof:      Furnace:      Electrical:      Plumbing:

Basement:         If yes, is it finished:         Square Foot of Finished Basement:

Attached Garage:         Cars:

Coverage

A. Dwelling Amount $                   

B. Other Structures $                   Pool:         If yes, is it fenced?

C. Personal Property (Owner's) $        Trampoline:  

D. Loss of Rents $                      Wood-burning stove:

E. Personal Liability $                     Fire Alarm:      

F. Medical Pay $                                Deductible:

3-Year Loss History (Include date and description):

Date: //        Description:

Date: //        Description:

Date: //        Description:

 

 

 Is there anything else we should know regarding your rental dwelling insurance?

 

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