1–4 Unit Rental Dwelling Insurance

Landlord coverage built for single-family rentals, duplexes, triplexes, and fourplexes. Complete the intake below and we will shop top carriers for the right DP3 or landlord solution.

Personal Information

Name

Date of Birth (MM/DD/YYYY)

Your Physical Home Address

Mailing same as home address

Mailing Address

Driver License # / State

Last 4 of SS

Highest Level of Education Completed

Marital Status

Occupation & Industry

Veteran?

Phone

How did you hear about us?

Spouse Information

Name

Date of Birth (MM/DD/YYYY)

Driver License # / State

Last 4 of SS

Highest Level of Education Completed

Occupation & Industry

Veteran?

Phone

Other Co-Owners

Property Management Company

Company Name

Contact

Phone

Website

Ownership & Business

Ownership Structure

Entity Name

Do you have employees?

How many employees?

Where does your business operate?

Business Location Address

Occupancy

Property Details

Address

Purchase Date (MM/DD/YYYY)

Year Built

Total Square Footage

Size of Lot

Total Number of Bathrooms

Number of Floors

Total Fireplaces (gas or solid fuel)

Stove Used as Heat Source?

Thermostatically Controlled Heat?

Heat Source

Cooling System

Construction

Exterior Building Materials

Foundation Type

Roof Shape ?

Year Roof Was Last Replaced

Roof Material

Year Plumbing Fully Replaced

Year Plumbing Partially Replaced

Plumbing Material

Year Electrical Wiring Fully Replaced

Year Electrical Wiring Partially Replaced

Electrical Wiring Type

Electrical Panel Type

Year Last Water Heater Was Replaced

Systems, Safety & Risk

Year Plumbing Fully Replaced

Year Plumbing Partially Replaced

Plumbing Material

Electrical Fully Replaced

Electrical Partially Replaced

Electrical Panel Type

Water Heater Year

Garage?

Pool / Hot Tub?

Animals / Dogs?

Trampoline / Ramp?

Monitored Alarm?

Gas Shut-Off Valve?

Water Sensor?

Gutters?

Gutter Guards?

Open Eaves ?

High Risk Questions

In City Limits?

Miles to Fire Station

Fire Station Name

Hydrant Distance (ft)

Firewise Community?

Distance to Brush / Trees

Distance to Water (miles)

County

Subdivision / HOA

Lienholder

This property has a lender

Prior Insurance & Claims

Most Recent Carrier

Current Premium

Policy Period

Coverages

A - Dwelling

B - Other Structures

C - Personal Property

D - Loss of Use

E - Liability

F - MedPay

Water Backup

Personal Injury

Deductible

Additional Notes & Uploads

Notes

Upload Files (current declaration pages, photos, inspection reports, appraisals, repair estimates, wind mitigation reports, etc.)

All information is kept confidential and used solely for quoting purposes.