• Features
  • Plans & Pricing
  • About
  • Login
  • Sign Up

Renters Insurance Form

  • What is your first name? *
  • What is your last name? *
  • What is your preferred phone number? *
  • Please enter your email: *
  • What is your occupation and employer name?
  • Please enter your date of birth. *
    MM slash DD slash YYYY
  • Will anyone else be named on this quote?
  • Please enter their name:
  • Please enter their occupation and employer name:
  • Please enter their date of birth.
    MM slash DD slash YYYY
  • Please enter the address of the location you would like a quote for. (Include apartment number, if applicable) *
  • What type of property will you be renting?
  • Please provide a brief description of the property you will be renting.
  • This field is hidden when viewing the form
    What date would you like the insurance to commence on? (MM/DD/YYYY)
  • MM slash DD slash YYYY
    What date would you like the insurance to commence on? *
  • Please select the occupancy of this property.
  • Please describe the occupancy of the property.
  • Please enter your primary/current address. (Include apartment number, if applicable)
  • Is there an active monitored alarm system in this residence?
  • Select the components of your alarm system.
  • What is the approximate value of the personal belongings you will have at this residence? (Personal belongings include furniture, clothing, electronics, kitchen items, linens, and other possessions that you own.)
  • Please select the categories of valuable articles that you will keep at this residence.
  • Please provide details about your jewelry.
    Total collection value ($)Total number of piecesValue of Most Significant Piece ($) 
  • Please provide details about your fine art.
    Total collection value ($)Total number of piecesValue of Most Significant Piece ($) 
  • Please provide details about your silverware.
    Total collection value ($)Total number of piecesValue of Most Significant Piece ($) 
  • Please provide details about your firearms.
    Total collection value ($)Total number of piecesValue of Most Significant Piece ($) 
  • Please provide details about your wine collection.
    Total collection value ($)Total number of bottlesValue of Most Significant bottle ($) 
  • Please provide details about your other valuables.
    Collection descriptionTotal value of collection ($)Value of Most Significant piece ($) 
  • What is the approximate square footage of this property?
  • What year was this residence built? (YYYY)
  • What was the primary construction material used to build this residence?
  • Please select the other structures at this residence.
  • Would you like a flood insurance proposal for your rental?
  • Documents and Comments

  • Please use this field to upload any relevant insurance documents. (ie. Current policy declarations pages, appraisals, etc...)
    Drop files here or
    Accepted file types: jpg, gif, tiff, png, pdf, Max. file size: 128 MB, Max. files: 5.
    • Please enter any additional remarks in the space below.
    • How did you hear about us?
    • Please share who referred you to us.
    • Please share what you typed into Google.
    • Please share how you heard about us.
    • Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.

      Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.
    Save & Continue LaterAgent Save & Continue
    RiskRevuTM Newsletter

    Want to learn how digital forms can help modernize your agency? Sign up for our Newsletter here:

    • This field is for validation purposes and should be left unchanged.
    • Features
    • Plans & Pricing
    • About
    • Blog
    • Login
    • Sign Up
    Contact
    • Customer Support

    © 2025 RiskRevu. All rights reserved.   Privacy Policy   |   Terms of Service   |   Security Overview   |   California Residents