Renters Insurance Quote Request

 

ABOUT THE RENTER
Name:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Phone:	Zip Code:
Birthday:
E-mail:
Confirm E-mail:
	If you are a resident of a state other than CA, prior address is required if you have not been at your current address for at least 3 years.
Previous Address:
City:	State: AZ CA NV

 

About your Rental Unit / Apartment
Year Rented:		Size (in sq feet):
Number of Bedrooms:	1 2 3 4 5 6 7 8        Bathrooms  1 1.25 1.5 1.75 2 2.25 2.5 2.75 3 3.25 3.5 3.75 4
Roof Type:	Tiles Asphalt Composite Wood Shingles Not Sure What Type
Liability Limits:	$10k $25k  $100k $300k$500k
Personal Property Coverage:	$ ($5,000 minimum included)
Other:	Do you have a pet?   If yes, choose amount of animal coverage: No Coverage $25,000 $50,000 $100,000 $300,000
	Prior losses or claims? Wood-burning Stove?
	Is the dwelling within 500 feet of native brush, or isolated or inaccessible to fire fighting equipment? Yes     No
	Do you currently have insurance (if yes, with what carrier?
	What is your current yearly or monthly premium?
	Do you have any other information about your rental or apartment, or comments that you would like to share? Please place special requests here, such as extra coverage for special items.

NO COVERAGE IS BOUND, OFFERED, ISSUED THROUGH THIS ELECTRONIC COMMUNICATION, ALL POLICIES MUST BE UNDERWRITTEN AND APPROVED BY THE CARRIER. DO NOT CANCEL YOUR CURRENT INSURANCE.

Copyright 2008 Stratum Insurance Agency, LLC