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Property Insurance
Condominium
Renters
Fire/Landlord/Dwelling
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Property Quote Sheet
YOUR PERSONAL DATA:
Name
:
Phone : (home)
:
(work)
:
Spouse Name (if applicable) :
Business Name (if applicable) :
Property address
:
City
:
State
:
Zip Code
:
Current address :
:
City
:
State
:
Zip Code
:
Date of birth
:
SSN
*
:
(Spouse) Date of birth
:
SSN
*
:
Occupation
:
(Spouse) Occupation
:
Replacement cost of home :
Mortgage company :
Year built :
Brick
Frame
Animals
: Yes
No
Fenced yard
: Yes
No
Square feet :
Stories :
Bi-level
Tri-level
Fireplace : Yes
No
Wood stove : Yes
No
Swimming pool/hot tub : Yes
No
If building is older than 20 years, have utilities been updated?
Plumbing : Yes
No
Wiring/breakers : Yes
No
Roof : Yes
No
When?
When?
When?
When?
Material?
Current insurance :
Policy number :
Expiration date
Property claims: (please include date, type of loss, and the amount paid out)
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216-691-9227
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216-691-9552
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