Contact Information
Name
*
*
Property Address:
*
*
*
*
E-mail:
*
Phone Number:
*
Property Details
How would you describe your home?
*
Select
Primary home
Seasonal home
Secondary Home
Rental property
Vacant
Do You currently live at this property?
*
Yes
No
Do You currently have condo insurance policy?
*
Yes
No
Have you had a claim or loss at any residence during the past five years?
*
Yes
No
Briefly Describe the Loss
*
Approximate date of loss:
*
Additional Property Information
Approximate Year Built:
*
Number of Stories:
*
Approximate living area (sq.Ft):
*
Construction Type
*
Select
Frame
Veneer
Masonry
Superior
Roof Type
*
Select
Tile
Slate
Metal
Wood shake
Other
Distance from Fire Station
*
Select
5 miles or less
Over 5 miles
Δ
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