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Dwelling Fire/Landlord Policy
Dwelling Fire/Landlord Policy
Name/Business Name the Property Is In
Primary Contact Name
Primary Contact Address
Primary Contact Date of Birth
MM slash DD slash YYYY
Primary Contact Email
Primary Contact Phone
Texting
*
I consent to receive text messages at the provided number
I opt out of text messages
Insured Location Address
Mailing Address of Property Owner
EIN (if applicable)
Dwelling Coverage Amount
How much do you want the property insured for?
Year of Roof
Year of Central Heating System
Year of Plumbing
Year of Electrical
Is the property rented on a 12 month basis or shorter term such as Air BNB or similar service?
How much are annual rents?
Is there a property manager?
Yes
No
Is the property currently occupied?
Yes
No
Is there a pet policy enforced?
Yes
No
Do you require tenants to have liability insurance (renters insurance)?
Yes
No
Is the property currently insured or new purchase?
Currently Insured
New Purchase
What is the closing date?
MM slash DD slash YYYY
Do you have a mortgage on the property?
Yes
No
Will the insurance premium be escrowed?
Yes
No
Is there a pool, trampoline, or other increased hazard on the property?
Yes
No
Additional Comments
Consent
*
By providing your phone number, you consent to receive text messages at the provided number.
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