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1-214-351-4097
2626 Cole Ave. Suite 300
Dallas, TX 74204
09:00 am - 06:00 pm
Mon - Fri
Commercial Property Insurance Quote One Simple Form - takes only 2-3 Minutes! Need Help? Phone 214-351-4097
Owners Information
*
Required Field
Name:
Type if Known Recommend Coverage?s DP1 Dwelling Basic DP2 Dwelling Extended DP3 Broad Coverage Fire Only Policy Home Owners Primary HOA Home Owners Primary HOB Fire EC VMM Retail Structure Industrial
Business Entity Name: if applicable
Property Address:
City:
State:
Zip Code:
County:
Date of Birth
if owner:
Date Established
if other
Email:
Phone:
Alternate Phone:
Property Information
Year Built:
* Purchase Date
Property Type and Usage:
Single Family Dwelling Town House Multi Family Condo Unit Apartments Professional Building Retail Structure Industrial Manufacturing Small or Home Office Rented to others Owner Occupied Vacant
Approx Sq Ft.
Number of Stories:
1 Story 2 Story 3 Story 4 Story
Number of units:
1 2 Specify
Type of Construction
Brick Wood Steel Stucco Brick Veneer Aluminum Siding Stone Block Hollow Tile Abestos Siding Other Other
Type of Roof:
Composition Wood Shingles Metal Roof Aluminum Shingle Terra Cotta Slate Tar and Gravel Rubber roof Other Other
Is there A Pool ?:
Yes No
If Yes, Is it Fenced or Gated Yes No
Is the property within 500 ft of a lake, pond or large body of water?
Nearest Fire Station:
Prior Claims? :
Type:
Date (mm/yy):
Amount paid:
None Hail / Wind Fire Water Burglary
Hail / Wind Fire Water Burglary
How is your Credit History?
Good Credit Fair Credit Poor Credit Bad Credit Very Bad Credit
(Some Carriers use credit history to quote)
( Bad Credit is OK, We have programs for all)
Protective Devices?
None Burglar / Fire Monitored Alarm Burglar Monitored Alarm Fire Monitored Alarm Burglar Local Alarm Fire Local Alarm Burglar / Fire Local Alarm
Home Updates?
Roof
Electrical
Plumbing
AC / Heat
Current Mortgage?
Yes No (Is their a Mortage on this property?)
Currently Insured?
Current Insurance Co. Name?
Current Annual Premium?
Expiration Date?
Coverage Requested
Property Coverage.
Property Value
$
Loss of use Revenue Coverage
None 10 percent $100,000 $200,000 $300,000 $500,000 1 Mil
Liability Coverage.
$0.00 $25,000 $100,000 $200,000 $300,000 $500,000 1 Mil
Unscheduled Contents
Default is 25 K Non Luxury items
Desired Coverage Valuation Method
Market Value - ACV Replacement Cost Recommend Coverage
Hurricane Coverage Needed?
Desired Deductible:
1 % 2 %
Comments / Remarks (Describe any additional information you feel may be helpful in determining your quote or coverage).
My preferred Contact:
* Email Call by Phone
Thank you for filling out Our Quote Request Form!
Disclaimer Notice: - The premiums quoted are estimates based in the information you provided. If you have any questions or other pertinent information you feel necessary to properly quote your insurance Please feel free to contact our office at the number above for a personalized quote.
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