Commercial Property Questionnaire
Complete this form to request an insurance proposal for a vacant property or a rental property
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Email *
How did you hear about us?
Company/Entity Name *
Your EIN *
Enter your First and Last Name *
Office Phone (xxx-xxx-xxxx) *
Mobile Phone (xxx-xxx-xxxx) *
Complete mailing address including city, state and zip code (must be different from property address) *
Insurance Status *
When do you want coverage to begin *
Complete property address including city, state and zip code (Property #1) *
Property Type *
Is the property vacant? *
Is the property boarded up and secured? *
Has the property been renovated *
What year were the following updates completed: electrical, plumbing, roof, hvac? *
Please select the correct electrical system (Check ALL that apply) *
Required
Please select the correct HVAC system *
Has the property experienced fire or water damage *
Purchase Date *
MM
/
DD
/
YYYY
Purchase Price *
Appraisal Value *
Monthly rent per unit
Date rented
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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