APPLICATION

Home, renters and condo application

Details about the property and the people living there. If you are closing on a home, include the closing date and your lender so the evidence of insurance is ready in time.

Your contact information

Full name

Mobile phone

Preferred language

Street address

City

State

ZIP code

Applicant

Date of birth

Social Security number Used to rate the policy. Leave blank if you do not have one. Sent and stored encrypted.

Co-applicant name and date of birth

Co-applicant Social Security number Used to rate the policy. Leave blank if you do not have one. Sent and stored encrypted.

Property

Policy type

Property address, if different from above

Year built

Living area in square feet

Construction

Roof type

Roof age in years

Occupancy

Purchase price or estimated value

Estimated value of belongings

Protective devices

Dogs on the property?

Dog breeds, if any

Swimming pool or trampoline?

Mortgage and closing

Mortgage lender or landlord name

Lender address for the evidence of insurance

Loan number, if known

Closing or move-in date

Claims and prior insurance

Property claims in the last 5 years Date and type, or "none"

Current or most recent carrier

When do you need coverage to start?

Would you like an auto quote too?

Anything else

Notes for the agent