Condominium insurance Our process is transparentFor Help Call 1-(248)-856-9000 PERSONAL INFORMATION Fields marked (*) are mandatory NAME ADDRESS CITY STATE Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP CODE PROPERTY ADDRESS (IF DIFFERENT FROM ABOVE) DAY PHONE NIGHT PHONE BEST TIME TO CALL E-MAIL ADDRESS OCCUPATION HOW LONG AT CURRENT JOB DATE OF BIRTH SMOKER? Yes No CURRENT INSURANCE INFORMATION Fields marked (*) are mandatory COMPANY NAME (NOT AGENCY) POLICY EXPIRATION DATE PREMIUM AMOUNT POLICY TYPE Primary Secondary TERM 6 Months 1 Year Other TERM OTHER HAVE YOU FIELD ANY PROPERTY CLAIMS IN THE PAST 3 YEARS? Yes No IF "YES", PLEASE GIVE US CLAIM DETAILS CONDOMINIUM INFORMATION CONDOMINIUM IS Owner Occupied Rented to Others LIVING AREA SQ FT NUMBER OF UNITS IN YOUR BUILDING YEAR BUILT COPPER PLUMBING? Yes No CIRCUIT BREAKERS Yes No ALARM SYSTEM IS THE HOME/APARTMENT EQUIPPED WITH AT LEAST ONE WORKING SMOKOE ALARM? Yes No DOES YOUR HOME HAVE AT LEAST ONE FIRE EXTINGUISHER THAT IS 2 1/2 IBS. OR LARGER? Yes No DO ALL EXTERIOR DOORS HAVE DEADBOLT TYPE LOCKS? Yes No DESIRED COVERAGES DEDUCTIBLE COMPREHENSIVE PERSONAL LIABILITY VALUE OF YOUR CONTENTS LIST ANY ADDITIONAL COVERAGE REQUIREMENTS ADDITIONAL COMMENTS PLEASE GIVE ANY ADDITIONAL COMMENTS YOU FEEL APPROPRIATE FOR THIS QUOTATION. IF YOU HAVE ADDITIONAL INFORMATION WHERE THERE WAS NOT ENOUGH SPACE, PLEASE ENTER THEM HERE Send