Please answer the questions below
for Your No Obligation, No Risk,
Free Renters Insurance Quote
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone:
Email:
Do you currently have insurance?
Yes
No
If "Yes", when does your current policy expire?
If "Yes", what is your premium?
If "Yes", who are you currently insured with?
Monthly Rent:
Square Footage:
Number of Total Units in Building:
Amount of Coverage Desired:
Is your home is susceptible to flooding?
Yes
No
Is your home built on a hillside?
Yes
No
Is your home located within a brush hazard area?
Yes
No
Do you have a dog?
Yes
No
Are there any firearms in your home?
Yes
No
Is there a central alarm system?
Yes
No
Is there a 24 hour doorman?
Yes
No
Have you filed any claims within the last 5 years?
Yes
No
Number of stories?
1
2
3
4
5
6
Over 6
How many rooms
5
5 1/2
6
6 1/2
7
7 1/2
8
8 1/2
9
9 1/2
10
10 1/2
11
11 1/2
12
12 1/2
13
13 1/2
14
14 1/2
15
How many living in the residence?
1
2
3
4
5+
What part of the year is the home occupied?
Year Round
Seasonal
Never
Do you have a basement?
No Basement
Unfinished
Partly Finished
Fully Finished
Slab
Crawl Space
Other
Do you have a garage?
No Garage
Carport
Attached One Car
Attached Two Car
Attached Three Car
Unattached One Car
Unattached Two Car
Unattached Three Car
Other
How many bathrooms?
1
1 1/2
2
2 1/2
3
3 1/2
4
4 1/2
5
5+
How many bedrooms?
1
1 1/2
2
2 1/2
3
3 1/2
4
4 1/2
5
5+
Type of exterior wall
Adobe
Aluminum/Vinyl Siding
Asphalt
Brick Veneer
Cement Fiber
Clap Board
Concrete Block
Log Siding
Logs
Mineral Fiber
Painted Masonry
Precast Concrete
Precast Stone
Slump Block
Split Block
Solid Brick
Solid Stone
Stone Veneer
Stucco on Frame
Stucco on Masonry
Wood Shakes
Wood Siding
Other / Not Sure
Type of roof
Architectural Shingles
Asphalt or Fiberglass Shingles
Built-Up/Tar and Gravel
Clay Tile
Concrete Tile
Corrugated Steel
Mineral Fiber Shakes
Mission Tile
Rock Roof
Roll Roof
Rubber Roof
Slate
Tin
Wood Fiber Shingles
Wood Shake
Other / Not Sure
Age of Roof?
1 year old
2 years old
3 years old
4 years old
5 years old
6 - 10 years old
10 - 15 years old
15 - 20 years old
20 -25 years old
25 - 30 years old
30+ years old
Type of foundation
Crawl Space
Piers/Pilings/Stilts
Slab on Grade
Walkout Basement
Wood Foundation Basement
Unfinished Basement
Other / Not Sure
Rate your own credit
Excellent
Minor problems
Bad
Horrible
Home
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