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Bob Walenta 

Sheila & Robin

Personal Lines Customer Service

 Apartment Bldg. Quote 
Form:Dwelling Fire/Apartment Building Insurance Quote
Dwelling Fire/Apartment Building Insurance Quote




Contact Information
Name of Business:
Contact Name:
Address:
City:
State: Zip:
Business Phone:
Fax Number:
Contact Email Address:
Property Information
Address of Property:
Property City:
Property State:
Property Zip:
New purchase Existing ownership
Number of units:
Building Square footage:
Year Built:
Occupancy:
Owner Tenant
Occupancy Type:
Plumbing type:
Copper Galvanized Mixed (Copper/Galvanized)
Foundation Type:
Slab
Crawlspace over slab
Pier & Post
Other (list in remarks)
Type finished basement, if any:
None Full 25% 50% 75%
Type Roof:
Shingle
Wood Shake
Tar/Gravel
Spanish Tile
Metal
Other
Type of Siding:
Brick Vinyl Wood Aluminum
Number of stories:
1 2 3 4 or more
# of feet to nearest fire hydrant:
# of miles to nearest fire station:
Currently Insured?
Name of Carrier & how long insured?
Yes No
Coverage'ss
Building Coverage
$
Liability Coverage
$
Contents
$
                      Deductible $
($250, $500, $1,000, etc.)
$
Other Coverage/Remarks:
(describe any extra coverage's
needed such as businessinterruption,
robbery, computers, etc.):
Any claims reported on this property:
or previously owned properties in
the last 3 years?
Yes No
Please describe: Include date(s) and:
details of claim
Additional Comments
Please give any additional comments or questions

No coverage of any kind is bound or implied by submitting information via this online form

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