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Vacant Property Quote Form
Completing this form thoroughly will allow you to receive the most accurate quote.
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Indicates required field
Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Email
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Contact Phone
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Phone Number
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Current Insurance Company
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Property Information
Enter the details about your property. If you are unsure for any items just leave blank.
Enter Property Address (only if different than above)
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Line 1
Line 2
City
State
Zip Code
Country
Construction Type
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Frame
Joisted Masonry
All Concrete
Other
Year Built
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Square Footage
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Enter square footage of home excluding basement.
Age of Roof
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Enter the year the last roof was installed.
Type of Roof
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Enter the type of roof such as flat tar, flat gravel, metal, shingles, clay tiles, etc.
Age of HVAC & Type
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Enter the year the Heat & Air system was installed or last updated. Also list if Gas or Electric
Age of Electrical System
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Enter the year the electrical system was installed or updated. List if circuit breakers (B) or fusses (F).
Age of Plumbing & Type Pipes
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Enter the year the plumbing was installed or last updated. Also list whether the pipes are PVC, Copper or Iron.
Amount of Coverage Desired
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Enter the amount of insurance needed.
Liability Limit
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Deductible
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Mortgage Co name, address and loan number
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Choose Any That Apply
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Central Station Monitored Alarm
Prior Cliams
No Prior Claims
Notes
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Enter any notes such as claims information or description of your type of pets here.
Upload Current Insurance Info
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Max file size: 20MB
You can upload your current insurance declaration page here.
Upload Other Documents
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Max file size: 20MB
You can use this area to upload any other document such as alarm monitoring certificate or pictures of your property.
Submit
