Landlord's Insurance Quote Request QUOTE Enter some information about the property and we’ll get started on your landlord’s insurance quote. Name (required) Full Name of Deeded Owner if Covering Building Email (required) Phone Quote Type —New CoverageReplacement Coverage Mailing Address Property Address County Year House Built Date House Purchased Type of Home BrickStick BuiltSingle Wide Manufactured HomeDouble Wide Manufactured HomeModular Have you had any losses or claims in the past five years? [radio 5yr-losses use_label_element default:2 “Yes” “No”] Pets Are there any pets in the house? YesNo If there are pets, what kind and how many? Roof If the house is over 20 years old, when was the roof last replaced? Type of Roof ShingleMetal Heating If the house is over 20 years old, when was the furnace installed? What type of heat do you have? Do you have alternate sources of heat? If so, what type? Electrical What type of electrical is in the house? Circuit BreakersFuses If fuses, how many amps service? If the house is over 30 years old, when was the electrical last updated? Fire Department Which fire department would respond to your house? How close is the fire department? How close is the nearest fire hydrant? Detached Structures Are there any detached structures? If so, please explain. Property Information # of Family Home? Size (length and width, sq footage) Number of stories Are there smoke alarms? Does it have fire extinguishers? Does it have deadbolt locks? Does it have a central station fire, burglar or temperature alarms? YesNo Does it have an automatic hardwired backup generator? YesNo Owner Owner’s Social Security # Owner’s Date of Birth Supporting Documents (Optional) For an easy comparative quote attach a photo or scanned copy of your existing insurance policy. Upload a pdf from a computer or snap a picture of the document with your phone’s camera. Supporting Documents Comments In connection with this application for insurance, we may review your credit report or obtain or use a credit-based insurance score based on the information contained in that credit report. We may also collect information from consumer reporting agencies such as driving records and claims history.