EPIA INC.
PROPERTY INSURANCE QUOTE REQUEST FORM  
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Contact Person  *

Insured name 

Birthday 

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Phone Number   *

Email Address

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Property Address to be Insured   *
Zip code  *
Total building area (sq. ft.) 

Insured occupied area (sq.ft.)  

Ownership of above property   
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Commercial use / Residential   
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Number of units 
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Number of floors 
Underground Parking? 
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Number of Parking Spaces 
Fire Escape 
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Number of Stories 

Year of the Building 

Now this property is Tenant or Vacant? 

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Number of people living in the home  

Additional Insured/Mortgagee/Loss Payee/Vendors Endorsement required? 

Construction type  
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Building Value ($)  
New business or Policy Renewal? 
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If it is a renewal, what is the date of your renewal? 
MM
/
DD
/
YYYY
Did you claim any losses before? 
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Any Previous claims?  
Prior Insurance 

Target premium amount 

Additional notes
How did you hear about us  *
Email additional attachments to contact@epiagroup.com
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