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RENTERS INSURANCE
Submitted by
insureitsmart
on Tue, 03/26/2019 - 07:11
1
Start
2
Complete
ABOUT YOU
First Name
Last Name
Email
*
Street Address
City
State
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Phone(Day)
Phone(Evening)
Fax
Date OF Birth
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
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Nov
Dec
Day
Day
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Year
Year
1944
1945
1946
1947
1948
1949
1950
1951
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1961
1962
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2008
2009
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2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
YOUR HOME INSURANCE INFORMATION
Do you currently have renters insurance ?
Yes
No
If you answered 'yes' to having renters insurance
When does your current policy expire?
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
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28
29
30
31
Year
Year
2022
2023
2024
2025
2026
Who are you currently insured with?
Monthly Rent
$
Interior Square Footage
sq.ft.
Approximate Year Built
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Amount of Coverage Desired
*
$
Is your home located within 1,000 feet of a fire hydrant?
Yes
No
Is your home located within 5 miles of a fire station?
Yes
No
Is your home susceptible to flooding or high water?
Yes
No
Is your home built on a hillside?
Yes
No
Is your area prone to landslides and/or sinkholes?
Yes
No
Is your home located within a brush hazard area?
Yes
No
Do you have a dog?
Yes
No
Are there any firearms in your home?
Yes
No
Is there a central alarm system?
Yes
No
Have you experienced any losses or filed any claims within the last 5 years?
Yes
No
Rate your own credit
- None -
Excellent
Minor problems
Bad
Horrible
Any Comments / Questions?
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