| Name: |
|
Location
of Apt: (City) |
|
| Year
Built: |
|
Number of
families: |
|
| Home Use: |
Primary Vacation |
Amount of
Coverage on Contents ($): |
16,000 is minimum |
| Owner
Occupied: |
Yes No |
Type
Structure: |
|
| Deductible
Amounts: |
|
Liability
Amounts: |
|
| Smokers: |
Yes No |
Alarm
Systems: |
Smoke Detector
Alarm sounds on premise
only
Central Answer Service Alarm
Deadbolts |
| Have
any pets: dogs, horses, or exotic animals, etc. |
Yes
No |
| If
so enter kind, breed, and age |
|
Number
of Apt Claims in the Last 3 Years
(please describe): |
|
| Daytime
Phone: |
|
Fax: |
|
| Email
Address: |
|
Apt.
Currently Insured: |
Yes No |
