Rental Property Insurance Quote Form
In order to give you a accurate quote please fill out this form completely.
Fields marked with * are required!
Your Information:
Property Owner:*
Rental Property Address*
City, State, and Zip Code*
Mail Address:
Mail: City, State and Zip Code
Phone #:
Fax #:
E-mail address:*
Are you currently insured?
Yes
No
Current insurance company:
Policy expires:
Amount of Existing Coverage?
Have you reported any property claims in the last 3yrs?
Yes
No
If yes, please give claim details below:
Date of Loss:(mm/dd/yyyy) Cost of the Claim:($0,000,000.00) What Caused the Loss: (fire, wind, flood, dog, vandals, ect.) Additional Details: (Please be specific)
Property Information:
Number of Units:
One Unit
Two Units
Three Units
Four Units
Five Units
Six Units
8 Units
10 Units
12 Units
14 Units
16 Units
18 Units
20 Units
More than 20 Units
Number of Stories:
One Story
Two Story
Split Level
3 Story
4 Story
Type of Garage:
One Car Attached
Car Port
Two Car Attached
Three Car Attached
Detached Garage
Type of Roof:
Tile
Spanish Tile
Asphalt Composition
Wood Shake
Rock
Living area square feet:
Year built:
Do all exterior doors have dead-bolt locks?
Does the home have at least one fire extinguisher 2½ pound or larger?
Is the home equipped with at least one working smoke detector?
Yes
No
Yes
No
Yes
No
Exterior Walls:
(enter percent of each type on your home)
Stucco on Frame:
Stucco on Masonry:
Paint on Masonry:
Wood Siding:
Aluminum Siding:
Wood Shakes:
Brick Veneer:
Stone Veneer:
Solid Brick:
Total must equal 100%
Home Enhancements:
(check the box if your home has any of the following items.)
Burglar Alarm
Fireplace
Swimming Pool
Central Vacuum
Trash Compactor
Solar Panels
Intercom System
Electric Air Cleaner
Sauna
Stained Glass Windows
Second Air Conditioner
Interior Walls:
Drywall
Plaster
Number of Bathrooms:
1
1½
2
2½
3
3½
4
4½
5
Bathrooms
Other Home Enhancements:
0
1
2
3
Garage Door Openers
0
1
2
3
4
5
Skylights
0
1
2
3
Jacuzzi & Hot-tubs
0
1
2
3
Wet Bars
Cooling and Heating:
(check all that apply)
Central Heating & Air
Swamp Cooler
Wood Stove
Wall Heater With Thermostat
Wall Heater Without Thermostat
What coverages do you desire?
Deductible:
250
500
1000
2500
Liability Limit:
$100,000.00
$300,000.00
$500,000.00
$750,000.00
$1,000,000.00
$1,500,000.00
2,000,000.00
Other Coverages Requested:
ADDITIONAL COVERAGE:
Earthquake Coverage: Yes
No
Flood Coverage: Yes
No
Approximate Market Value
Closing Date
Enter Any Additional Remarks Here:
This page is provided as a service to you. It is not possible to bind any new coverage from this request. If you have NOT received your confirmation from us within 24 hours the same or next business day, please contact us.
NO COVERAGE IS CONSIDERED BOUND UNTIL YOU RECEIVE OUR CONFIRMATION
. Thank you for your understanding.
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We welcome the opportunity to serve you.
Ramsey Insurance Agency
License #
0490642