JGI - Condo

Condo Insurance Request

First Name

Last Name

Phone Number

Property Location Address

City

State

Zip

Property Address

City

State

Zip

How Many Stories:

1 Story, 1.5 Stories, 2 Stories, Split-Level, Other (please specify)

Construction Type:

Wood, Stucco, Masonry, Brick Veneer, Other (please specify)

Primary Residence?

Yes or No

How Many Units:

1, 2, 3, 4, 5+ (If more than 5, please specify)

What type of building is this?

Apartment, Condo, Townhouse, House, Manufactured/Mobile Home

Other Features:

Deadbolts, Smoke Detectors, Fire Extinguisher, Central Station Fire and/or Burglar Alarm, Swimming Pool, Trampoline, Other (please specify)

Carrier Name

Policy Number

Expiration Date

Current Coverage Limits

Current Deductible

Deductible

Amount of Liablity Desired

Is your home older than 20 years? If so, what updates have been done?

Date of Claim

Amount Paid

Claim Type

Description

Date of Claim

Amount Paid

Claim Type

Description

Additional Information

Please Note that coverage cannot be bound via quote request form