Yellowhammer Auto·Home·Life·Business · Apartment Bldg Quote · David Green · Independent Agent in Alabama, Georgia, Tennessee and Mississippi

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Apartment Bldg. Quote

Dwelling Fire/Apartment Building Insurance Quote
Contact Information:
1	First Name:
2	Last Name:
3	Daytime Telephone:
4	Evening Telephone:
5	Email:
6	Address:
7	City:
8	State:
9	Zip:
Property Information:
10	Address of Property:
11	Property City:
12	Property State:
13	Property Zip:
14		New purchase Existing ownership
15	Number of units:
16	Building Square footage:
17	Year Built:
18	Occupancy:	Owner Tenant
19	Occupancy Type:
20	Plumbing type:	Copper Galvanized Mixed (Copper/Galvanized)
21	Foundation Type:	Slab Crawlspace over slab Pier & Post Other (list in remarks)
22	Type finished basement, if any:	None Full 25% 50% 75%
23	Type Roof:	Shingle Wood Shake Tar/Gravel Spanish Tile Metal Other
24	Type of Siding:	Brick Vinyl Wood Aluminum
25	Number of stories:	1 2 3 4 or more
26	# of feet to nearest fire hydrant:
27	# of miles to nearest fire station:
28	Currently Insured? Name of Carrier & how long insured?	Yes No
Coverages:
29	Building Cov. $
30	Liability Cov. $
31	Contents $
32	Deductible $ ($250, $500, $1,000, etc.)
33	Other Coverage/Remarks: (describe any extra coverages needed such as business interruption, robbery, computers, etc.):
34	Any claims reported on this property or previously owned properties in the last 3 years?	Yes No
35	Please describe: Include date(s) and details of claim:
Comments or Questions:
36
37	Deliver quote via:	E-Mail Fax Regular Mail Telephone
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