What is your first name?
What is your last name?
What is your preferred phone number?
Please enter your email.
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Please enter your Date of Birth (MM/DD/YY):
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Please enter your Date of Birth.
MM slash DD slash YYYY
What is your marital status?
What is your spouse's full name?
What is your partner's full name?
What is your fiancé's full name?
Please enter their occupation.
Please enter their employer.
Please enter their date of birth.
MM slash DD slash YYYY
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Will anyone else be named on this quote?
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Please enter their name:
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Please enter their occupation and employer name:
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Please enter their Date of Birth (MM/DD/YYYY):
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Please enter their Date of Birth:
MM slash DD slash YYYY
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What is your relationship to them?
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Please describe your relationship with them.
Please enter the address of the condo/co-op you would like a proposal for (Include apartment number, if applicable).
Are you in the process of purchasing this condo/co-op?
Is this a Condominium or Cooperative?
What type of property is this?
What is the purchase price?
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What is the closing date? (MM/DD)
What is the closing date?
MM slash DD slash YYYY
What date do you want this coverage to start?
Please select the intended occupancy of the condo/co-op you are purchasing.
Please describe the intended occupancy of the home you are purchasing.
Please select the occupancy of this property.
What is the occupancy of this home?
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What is your current home address?
What is your primary home address?
Have you lived at your current address for three or more years?
Have you lived at your primary home address for three or more years?
Please provide the address where you lived prior to your current address?
Please provide the address where you lived prior to your current address?
Will you renovate this condo/co-op before moving in?
What is the renovation budget?
How long will the renovation take?
Please select the frequency of rentals for this Condo/Co-op.
Will there be a mortgage?
What is the name of the bank providing the mortgage?
Who is your contact at the bank?
What is the phone number for your contact at the bank?
What is the email address for your contact at the bank?
Is there a mortgage?
Please enter the bank name, if convenient. (Ex. Bank of America NA, ISAOA ATIMA)
Please enter the bank address, if convenient.
Please enter the loan number, if convenient.
Is this property owned by a Trust, LLC or Limited Partnership?
Please enter the name of the Trust, LLC or Limited Partnership:
Do you have an alarm system in your condo/co-op?
Select the components of your alarm system.
What other components do you have in your alarm system?
What is the approximate square footage of this property?
What year was this condo/co-op built?
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What year was this condo/co-op built?
MM slash DD slash YYYY
Do you have any information that will assist us in estimating the replacement cost of the improvements and betterments in this unit? (I.e. Recent renovation costs, ball park construction cost to rebuild the unit, any unique features, etc...)
Please share the information you have about the replacement cost of the improvements and betterments in this unit.
Select the systems that have been updated in the last 10 years.
What other systems have been updated?
What would it cost to replace your personal belongings at this location? (I.e. Clothing, furniture, rugs, electronics, etc...)
Do you plan to sell an existing residence? *
Please enter the address of the residence you plan to sell.
Would you like a flood insurance proposal for your Condo/Co-op?
Documents and Comments
Please use this field to upload any relevant insurance documents. (I.e. By-laws of the association, current policy declarations pages, etc...)
Please enter any additional remarks in the space below.
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.
