Landlord Insurance Questionnaire
When it comes to insurance, one size does not fit all. Please complete this form so we can design a custom plan for you. It's fast, easy and completely secure.
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What's your legal name? *

Your legal name is the name that identifies you for legal, administrative and other official purposes.
 
What's your preferred first name? *

 
Date of birth? *

 
Gender? *


 
Marital status? *


 
Social Security number? *

Your data is completely safe. We run our forms on Amazon Web Services (one of the most secure cloud computing environments on the planet) and we employ 128-bit SSL encryption for all data transfer on the platform and forms.
 
What's your street address? *

 
City? *

 
State? *

 
Zip? *

 
What's your mobile telephone number? *

 
How many rental properties do you want to insure? *

Please enter a numeral between 1 and 4.
 
Property information

 
Property street address? *

 
City? *

 
State? *

 
Zip? *

 
When did you purchase this property? *

 
Do you have a mortgage on this property? *


 
Do you escrow the property insurance? *

     
 
Do you have a home equity loan attached to this property? *

     
 
What name or names are on the title? *

 
Occupancy? *


 
Annual rental income? *

 
Year built? *

Not sure when your home was built? Try visiting your county assessor's website.
 
Property type? *


 
Property condition? *


 
Square footage? *

Do not include your basement.
 
Construction grade? *

Construction grade refers to the architecture, materials and quality of workmanship.

 
Construction style? *





















 
Exterior wall materials? *

Brick, wood siding, fiber-cement siding, stone, stucco, etc. (please provide percentage breakdown).
 
Roof materials? *

Asphalt shingle, rubber, wood shingle, copper, tile, etc.
 
Foundation type? *

Please choose A if your basement is partially finished.

 
Garage type and capacity? *


 
How many bedrooms? *

 
How many bathrooms? *

 
How many fireplaces? *

 
How many kitchens? *

 
Flooring materials? *

Carpet, wood, stone, tile, etc. (please provide percentage breakdown).
 
Wall and ceiling materials? *

Drywall, plaster, shiplap, stone, etc. (please provide percentage breakdown).
 
Please tell us about this property's HVAC system. *


 
Protective devices? *


 
Special features? *


 
Special risk factors? *


 
Property additions and/or renovations? *

Please describe the project and provide the year that it was completed.
 
Property information

 
Property street address? *

 
City? *

 
State? *

 
Zip? *

 
When did you purchase this property? *

 
Do you have a mortgage on this property? *


 
Do you escrow the property insurance? *

     
 
Do you have a home equity loan attached to this property? *

     
 
What name or names are on the title? *

 
Occupancy? *


 
Annual rental income? *

 
Year built? *

Not sure when your home was built? Try visiting your county assessor's website.
 
Property type? *


 
Property condition? *


 
Square footage? *

Do not include your basement.
 
Construction grade? *

Construction grade refers to the architecture, materials and quality of workmanship.

 
Construction style? *





















 
Exterior wall materials? *

Brick, wood siding, fiber-cement siding, stone, stucco, etc. (please provide percentage breakdown).
 
Roof materials? *

Asphalt shingle, rubber, wood shingle, copper, tile, etc.
 
Foundation type? *

Please choose A if your basement is partially finished.

 
Garage type and capacity? *


 
How many bedrooms? *

 
How many bathrooms? *

 
How many fireplaces? *

 
How many kitchens? *

 
Flooring materials? *

Carpet, wood, stone, tile, etc. (please provide percentage breakdown).
 
Wall and ceiling materials? *

Drywall, plaster, shiplap, stone, etc. (please provide percentage breakdown).
 
Please tell us about this property's HVAC system. *


 
Protective devices? *


 
Special features? *


 
Special risk factors? *


 
Property additions and/or renovations? *

Please describe the project and provide the year that it was completed.
 
Property information

 
Property street address? *

 
City? *

 
State? *

 
Zip? *

 
When did you purchase this property? *

 
Do you have a mortgage on this property? *


 
Do you escrow the property insurance? *

     
 
Do you have a home equity loan attached to this property? *

     
 
What name or names are on the title? *

 
Occupancy? *


 
Annual rental income? *

 
Year built? *

Not sure when your home was built? Try visiting your county assessor's website.
 
Property type? *


 
Property condition? *


 
Square footage? *

Do not include your basement.
 
Construction grade? *

Construction grade refers to the architecture, materials and quality of workmanship.

 
Construction style? *





















 
Exterior wall materials? *

Brick, wood siding, fiber-cement siding, stone, stucco, etc. (please provide percentage breakdown).
 
Roof materials? *

Asphalt shingle, rubber, wood shingle, copper, tile, etc.
 
Foundation type? *

Please choose A if your basement is partially finished.

 
Garage type and capacity? *


 
How many bedrooms? *

 
How many bathrooms? *

 
How many fireplaces? *

 
How many kitchens? *

 
Flooring materials? *

Carpet, wood, stone, tile, etc. (please provide percentage breakdown).
 
Wall and ceiling materials? *

Drywall, plaster, shiplap, stone, etc. (please provide percentage breakdown).
 
Please tell us about this property's HVAC system. *


 
Protective devices? *


 
Special features? *


 
Special risk factors? *


 
Property additions and/or renovations? *

Please describe the project and provide the year that it was completed.
 
Property information

 
Property street address? *

 
City? *

 
State? *

 
Zip? *

 
When did you purchase this property? *

 
Do you have a mortgage on this property? *


 
Do you escrow the property insurance? *

     
 
Do you have a home equity loan attached to this property? *

     
 
What name or names are on the title? *

 
Occupancy? *


 
Annual rental income? *

 
Year built? *

Not sure when your home was built? Try visiting your county assessor's website.
 
Property type? *


 
Property condition? *


 
Square footage? *

Do not include your basement.
 
Construction grade? *

Construction grade refers to the architecture, materials and quality of workmanship.

 
Construction style? *





















 
Exterior wall materials? *

Brick, wood siding, fiber-cement siding, stone, stucco, etc. (please provide percentage breakdown).
 
Roof materials? *

Asphalt shingle, rubber, wood shingle, copper, tile, etc.
 
Foundation type? *

Please choose A if your basement is partially finished.

 
Garage type and capacity? *


 
How many bedrooms? *

 
How many bathrooms? *

 
How many fireplaces? *

 
How many kitchens? *

 
Flooring materials? *

Carpet, wood, stone, tile, etc. (please provide percentage breakdown).
 
Wall and ceiling materials? *

Drywall, plaster, shiplap, stone, etc. (please provide percentage breakdown).
 
Please tell us about this property's HVAC system. *


 
Protective devices? *


 
Special features? *


 
Special risk factors? *


 
Property additions and/or renovations? *

Please describe the project and provide the year that it was completed.
 
Any insurance claims within the last 5 years? *

     
 
Claim information *

Please describe the claim or claims.
 
Do you want to see how your current plan stacks up against our proposed plan? *

     
 
Please attach your current declaration pages. *

 
Please rate this online form. *

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