Please fill out the following questionnaire
as completely as possible. Remember, the more accurate the information
is, the more accurate the quote will be
First Name
Last Name
Street Address
City
State
Zip
Phone
Fax
Email
What limit of Contents Coverage?
What limit of Loss of Use Coverage?
What limit of Liability Insurance?
What limit of Medical Payments Coverage?
What type of roof is on the condominium?
Wood Fire
Resistive
What type of construction is the condominium?
Wood
Frame Brick Masonry Veneer
What is the year of construction?
Was the condominium ever remodeled? If so, in what
year?
