Vacation Rental Home Supplemental Form

What is your first name? **

What is your first name? *

What is your last name? **

What is your last name? *

What is your email address? **

What is your email address? *

What is your phone number? **

What is your phone number? *

What is your primary mailing address? **

What is your primary mailing address? *

Street Address Address Line 2 City State ZIP Code

Is this the address of the rental property? **

Is this the address of the rental property? *

Yes
No

What is the location address of the rental property? **

What is the location address of the rental property? *

Street Address Address Line 2 City State ZIP Code

Please provide links to any websites and/or the name of any websites where the rental is advertised.

What length of time is the dwelling offered for rental? (Check all that apply)

Hourly
Daily
Weekly
Monthly
Annually
Other

Please describe the length of time the dwelling is offered for rental.

What is the minimum number of nights rented per rental term?

What is the cost per night rental rate?

How many weeks per year is the property rented?

What uses/purposes is the dwelling available for rent? (Check all that apply)

Residential
Corporate/Business/Networking
Photo/Film Shoot
Party/Reception/Wedding
Exhibit/Show
Meeting/Workshop/Training
Other

Please describe the other uses/purposes the dwelling is available to rent for.

What is the maximum number of tenants and their guests allowed in the dwelling?

Is there a management company contracted for this rental?

Yes
No

What is the name of the management company?

How are renters screened?

Who screens the renters?

Is the property inspected after each rental?

Yes
No

Please describe who inspects the property after each rental.

What is the minimum age for tenants?

Are there any employees? (Maids, Groundskeepers, Caretakers, etc.)

Yes
No

Do any of the employees live on the rental property?

Yes
No

Please provide a description of the employee living arrangement on the property.

Is there an enclosed swimming pool or trampoline on the rental property?

Yes
No

Please provide details about the pool or trampoline.

Do you use the property as secondary or seasonal residence?

Yes
No

How often to you use the residence?

Documents and Comments

Please use this field to upload any relevant insurance documents.

Drop files here or

Max. file size: 128 MB, Max. files: 10.

Please enter any additional remarks in the space below.

<font size="2" color="gray">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.*

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.

I agree *

Vacation Rental Home Supplemental Form

Documents and Comments

AJG (Ericson) Service

RiskRevu^TM Newsletter

Contact

Vacation Rental Home Supplemental Form

Documents and Comments

AJG (Ericson) Service

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RiskRevuTM Newsletter

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RiskRevu^TM Newsletter