Crown Island Insurance | Personal Insurance, Commercial Insurance, Surety/Bonds

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renters/condo Quote REQUEST

*This is for informational purposes only. A Crown Island Broker will contact you at the phone number or email address provided. Thank you for the opportunity.

How Did You Hear About Us?

Friends Name, or Explanation of Other Referral

Member of the following group and/or association

Your Name

Email Address

Phone

Premises Address

City

State

Zip

Do you own or rent the condo, apartment of dwelling in you are inquiring?

Own

Rent

Approximate Year Built

If home is over 20 years old, indicate any applicable updates (approximate, if known)

Roof Updated?

Full

Partial

Wiring Updated?

Full

Partial

Heating Updated?

Full

Partial

Plumbing Updated?

Full

Partial

Amount of Personal Property to Cover (minimum of $20,000)

Check all of the following functional protective devices in your residence:

Smoke Alarm

Fire Extinguisher

Local Burglar Alarm

Centrally Monitored Alarm System

Dead Bolt Locks

Indoor Sprinkler System

Do you have any of the following supplemental heating devices?

Fireplace

Wood Burning Stove

Gas Fireplace

Do you have any pets?

Yes

Do you have a trampoline?

Yes

Is the house located within 1,000 feet of a fire hydrant and 5 miles of a fire station?

Yes

Have you had any claims in the last 5 years?

Yes

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)?

Yes

If yes, please explain

Have you had a bankruptcy, repossession or foreclosure in the last 5 years?

Yes

Do you want earthquake coverage on this home?

Yes

Would you also like to receive a flood quote on this home?

Yes

Does your home have a basement?

Yes

Is the bank requiring this insurance for your loan?

Yes

Have you had any flood losses at your residence?

Yes

If yes, please explain

Additional Comments