Vacation Property Online Quote

First Name:

Initial:

Last Name:

First Name:

Initial:

Last Name:

Relationship to Primary Insured:

First Name:

Initial:

Last Name:

Relationship to Primary Insured:

First Name:

Initial:

Last Name:

Relationship to Primary Insured:

First Name:

Initial:

Last Name:

Relationship to Primary Insured:

First Name:

Initial:

Last Name:

Relationship to Primary Insured:

Please check this box if this property is vested in a business entity, other than an individual's names (ie. Corps, LLC, LLP or Trusts)

Primary Contact Phone Number:

Primary Contact Fax Number:

Primary Contact Email Address:

Preferred Time to Contact You:

Property Location:

Property Street Address:

City:

State:

Zip Code:

Mailing Address:

Mailing Street Address:

City:

State:

Zip Code:

Requested Effective Date (or Close of Escrow):

Is this a NEW PURCHASE Closing Escrow through a Title Company?

Yes

PLEASE RUSH!! Need Coverage ASAP to Close Escrow!

Name of Title Company:

Contact Person:

Title Company's Phone Number:

Escrow #:

Do you already have ownership of this property?

Yes

Purchase Date:

How did you find us?

Name of Current Insurance Company:

NONE

If Insured, Please Provide Current Dwelling/Building Coverage:

ANY Claims History in the past 5 years:

Yes

Loss Date:

$ Amount Paid:

Type of Loss:

Brief Description of Loss/Claim:

Loss Date:

$ Amount Paid:

Type of Loss:

Brief Description of Loss/Claim:

Remove

Loss Date:

$ Amount Paid:

Type of Loss:

Brief Description of Loss/Claim:

Remove

Add Another Loss/Claim

Property Management

**INFORMATION NOT REQUIRED**
However, it's very helpful in completing the application to issue the policy.

Do you currently (or plan) to use a Property Management Company:

Add Management as ADDITIONAL INSURED (No Extra Cost!!!)

Name of Management Company:

Manager's Name (Contact Person):

Street Address:

City:

State:

Zip Code:

Phone Number:

Manager's Email (Contact Person):

Management Company's Website:

Management Company's Listing Number to your property:

Do you have ANY links of your own listings advertising this property on websites such as VROB or Home Away? If so, please paste in text box:

Additional Interests

**INFORMATION NOT REQUIRED**
However, it's very helpful in completing the application to issue the policy.

First Mortgage Company:

Name of Mortgage Company:

Continue Mortgage Clause:

Mortgage Company Mailing Address:

City:

State:

Zip Code:

Phone Number:

Loan Number:

We have (or plan to have) an Escrow Impound Account to Pay the Annual Hazard Insurance Premium.

Other Interest:

Interest Type:

Name of Other Interest

Continue Name of Other Interest:

Other Interest Mailing Address:

City:

State:

Zip Code:

Phone Number:

Loan or Account Number (if Applicable):

Dwelling Reconstruction Information

The more accurate facts you can provide about this home's construction, the more accurately we can calculate your total replacement cost.

In YOUR opinion: What is the overall QUALITY of construction?:

Building Structure - Type of Construction:

Square Feet (Living Area Only):

Year of Construction (Originally):

Number of Stories:

Roof Type:

Size of Garage (# of Cars):

Number of Bathrooms:

Size of Kitchen:

Average Ceiling Height

Foundation Type:

Foundation Shape:

Property Slope:

Property Access:

Number of Cooling Systems:

Number of Fireplaces:

Primary Heat Source:

Number of Heating Systems:

Quantity

Additional Home Features (add as many as applicable):

Add More Features

Select Interior Floor Material (must equal 100%):

Remove

0% Combined Total

Add More Materials

Select Interior Wall Finish (must equal 100%):

0% Combined Total

Add More Finishes

Select Exterior Wall Material (must equal 100%):

0% Combined Total

Add More Materials

2nd Story Balcony: Yes No

Covered by Roof? Yes No

Surface Material:

Shape of Balcony:

Approximate Sq. Ft:

Wood Deck: Yes No

Deck Covered by Roof? Yes No

Material of Deck:

Shape of Deck:

Approximate Sq. Ft:

Any additional comments about the specific construction qualities of this property that we should know?

Underwriting Questions

Please answer ALL of the required underwriting questions.

If you answered YES to any of the above questions and want to explain (or add details), please use this text box below:

We will calculate the minimum building coverage for you. Please select your OTHER coverage desires...

Basic Coverages:

Dwelling/Building Coverage

Extended Replacement on Dwelling/Building with Ordinance/Law

Replacement Cost on Dwelling & Separate Structures

Separate Structures Coverage

Includes owned docks and/or piers

Personal Property Coverage

Replacement Cost on Personal Property

Actual Cash Value

Loss of Rents Coverage (Estimated Gross Annual Receipts)

Premises Liability Coverage

Include Personal Injury Liability Protection

Guest Medical Coverage

Optional Endorsements & Coverage:

Limited Theft Coverage:

Water Backup of Sewer & Drains:

Wind/Hail for Satellite Dishes:

Identity Fraud Expense:

Loss Assessment Coverage:

Flood Insurance:

Earthquake Insurance:

Excess/Umbrella Coverage:

Please select two optional deductibles for your quote:

Quote #1 - Policy Deductible

Quote #2 - Policy Deductible

Home Renovations	Fully Replaced	Partially Replaced	Year Completed
Roofing
Heating System
Plumbing System
Electrical System

Vacation Property Online Quote

Primary Named Insured:

Other Named Insured(s):

Property Location:

Mailing Address:

First Mortgage Company:

Other Interest:

Basic Coverages:

Optional Endorsements & Coverage:

Please select two optional deductibles for your quote: