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Condominium Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!

Your Personal Data

First Name: *

Last Name:

Property Address:

City:

State:

Zip/Postal:

E-Mail (REQUIRED):

E-Mail (again for accuracy):

Phone:

Fax (optional):

Condominium Information

Year Condo. Built:

Condo. Square footage:

# of units in building: 1 2 Units 3 units 4 or more

Type foundation: Slab Crawlspace over slab
Pier & Post Other (list in remarks)

Type Roof: Shingle Wood Shake
Tar/Gravel Spanish Tile
Metal Other

Number of stories: One Two
Three 4+<

Currently Insured? Yes No

Name of Carrier & how long insured?

Prior Claims? Yes No

Describe claims in detail:

Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)

Circuit Breakers or fuses? Breakers Fuses

# Bedrooms:

# Bathrooms:

# Fireplaces:

# Chimneys:

Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)

Coverages:

Interior bldg. additions $

Contents $

Liability Cov. $

Deductible $
($250, $500, $1,000, etc.)


Comments/Remarks : (describe any scheduled jewelry, in-home business, or other special coverages needed here)

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