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Mailing Features, Type
Landlord / Property Owner Contact Info
Full Name
*
First
Last
Phone Number
*
Email Address
*
Current Mailing Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Currently Insured?
*
Yes
No
Current Insurance Carrier Name
Policy Expiration Date
Rental Property Details
Rental Property Address to be Insured
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Property Type
*
Single Family Home
Townhouse
Condominium
Multi-Family 2-4 Units
Mobile / Manufactured
Number of Units in Building
*
Year Built
*
Square Footage
*
Number of Stories
*
1 Story
1.5 Story
2 Story
3+ Stories
Split Level
Construction Type
*
Frame / Wood
Masonry / Brick
Brick Veneer
Stucco
Roof Type
*
Asphalt Shingle
Tile
Metal
Flat / Tar
Slate
Approximate Roof Age in Years
*
Occupancy & Rental Terms
Occupancy Status
*
Currently Rented
Vacant / Looking for Tenants
Short-Term Rental / Airbnb / VRBO
Lease Term Length
*
Long-Term 12+ Months
Month-to-Month
Short-Term / Vacation Rental
Are written leases signed by all tenants?
*
Yes
No
Do Tenant/s have a Renters Policy
*
Yes
No
Property Features, Safety & Risk Factors
Foundation Type
*
Slab
Crawlspace
Full Unfinished Basement
Finished Basement
Heating System Type
*
Central Forced Air / Gas
Electric
Oil
Solar
Wood Stove
Protective Systems
Fire / Smoke Alarms
Fire Extinguishers
Water Leak Detection
Security Cameras
Automatic Sprinklers
Is there a Swimming Pool on the property?
*
Yes
No
Is it fully fenced with a self-latching gate?
*
Yes
No
Are pets allowed on the property?
*
Yes
No
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