Renter or Condo Insurance

You have selected a personal Renter or Condo Insurance Quote for the state of California only.

Note: In order to provide you with an accurate quotation, the fields marked with an
red asterisk ( * ) require data.

*Do you own the condo, apartment, or dwelling in which you live? : Yes   No
Year built (approximately)? :
If home is over 20 years old, indicate any applicable updates (approximate, if known)
Year Roof Updated :	Full   Partial
Year Wiring Updated :	Full   Partial
Year Heating Updated :	Full   Partial
Year Plumbing Updated :	Full   Partial
*What amount of personal property do you need to insure? (Minimum is $20,000.) :
Check all of the following functional protective devices in your residence:
smoke alarm fire extinguisher local burglar alarm centrally monitored burglar alarm and fire alarm		dead bolt locks indoor sprinkler system centrally monitored burglar alarm
Do you have any of the following supplemental heating devices?
fireplace wood burning stove		gas fireplace
	Do you have any pets on the premises(If yes, what breeds)?
*Do you have a trampoline on the premises? : Yes   No
Is the house located within 1,000 feet of a fire hydrant and 5 miles of a fire station? : Yes   No
*Have you had any claims in the last 5 years? : Yes   No
	If yes, please explain:
Do you need to itemize or schedule any personal property (insurance carriers limit coverage on jewelry, watches, furs, silverware, antiques, fine arts, guns and other items unless scheduled)?
	If yes, please indicate the type of coverage and the amount:
*Preferred deductible? $:	--Please Select-- 250 500 1,000 2,500
Have you had a bankruptcy, repossession or foreclosure in the last 5 years? : Yes   No
Do you want earthquake coverage on this home? Yes   No
Would you also like to receive a flood quote on this home? Yes   No
If yes, how much contents coverage would you like to include?:
Does your home have a basement? Yes   No
Is the bank requiring this insurance for your loan? Yes   No
Have you had any flood losses at your residence? Yes   No
	Additional Comments:
*How would you like to receive your quote? : --Please Select-- Phone Fax Email
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