Your Name Business Name Property Address City State Zip/Postal E-Mail Phone Fax   Dwelling Information Year Building Built Building Square footage Occupancy Owner Tenant Occupancy Type: (describe entities & and number of units, such as "4 unit apartment" or "2 offices and barber shop", etc.) Type foundation Slab Crawlspace over slab Pier & Post Other (list in remarks) Type finished basement, if any None Full 25% 50% 75% Type Roof Shingle Wood Shake Tar/Gravel Spanish Tile Metal Other Type of Siding Brick   Vinyl Wood   Aluminum Number of stories One Two Three 4 or more # of feet to nearest fire hydrant: # of miles to nearest fire station: Currently Insured? Yes No Name of Carrier & how long insured? Prior Claims? Yes No Describe claims in detail Plumbing type Copper Galvanized Mixed (Copper/Galvanized)   Coverages Building Cov. $ Contents $ Liability Cov. $ Deductible $ ($250, $500, $1,000, etc.) Other Coverage/Remarks (describe any extra coverages needed such as business interruption, robbery, computers, etc.) Send my quotation via E-Mail Fax Regular Mail Call Me by Phone