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Rental Property Quote Form (Ehlers)


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information
Are you working with someone within our Agency?
Required
First Name
Required
Last Name
Required
Street
Required
City
Required
State
Required
ZIP / Postal Code
Required
E-Mail Address
Required
Primary Phone Number
Required
Alternate Phone Number
Optional
Date of Birth
Required
/ /
Current Information
Property Address
Required
Lease Duration
Required
Is home currently vacant or for sale?
Required
Do you conduct business on premises?
Required
If yes to business on premises, please explain
Optional
How many rental units are owned?
Required
How are rental units deeded?
Required
Dwelling Information
Approximate Date of Purchase
Required
/ /
Year Built
Required
Type of Roof
Required
Roof Replacement Year
Required
Foundation Type
Required
Outside Structure Type
Required
Approximate Living Area Square Footage
Required
How many bedrooms?
Required
How many full baths?
Required
How many half baths?
Required
Kitchen Counter Tops
Required
Any Fireplaces?
Required
Any Wood burning Stoves?
Required
Number of Stories
Required
What type of Flooring do you have? Please provide approximate %
Required
Any specialty rooms?
Optional
Garage (How many cars?)
Required
Attached or Detached Garage
Required
Monitored Burglar Alarm
Required
Monitored Fire Alarm
Required
Fire Extinguisher
Required
Trampoline
Required
Any swimming pool?
Required
If yes to swimming pool or trampoline, are they behind a fence?
Optional
Dogs
Required
If dogs, please list breed. If mixed breed, please list prevalent breed
Optional
Any additional structures requiring coverage
Optional
Any Skylights?
Required
Any Solar Panels?
Required
Any updates to Heating, Electrical, Plumbing?
Optional
Any galvanized Plumbing?
Required
Heating Type?
Required
Approximate Miles to Fire Station
Required
Approximate Feet to Closest Fire Hyrant
Required
Gated Community
Required
If gated community, are there security guards?
Optional
Any other animals on premises?
Optional
Claims in Past 6 Years Weather or Non Weather
Optional
Current Mortgage on Home?
Required
Escrow Insurance?
Required
Current Dwelling Coverage
Required
Current Adjacent Structure Coverage?
Required
Current Personal Property?
Required
Current Additional Living Expenses/Loss of Use
Required
Current Liability Limits?
Required
Current Medical Payments
Required
Current Wind/Hail Deductible?
Required
Current Hurricane Deductible?
Required
Current All other Peril Deductible?
Required
Current Carrier
Required
Current Carrier Form
Required
Do you want replacement cost or actual cash value on dwelling?
Required
Current Months with Carrier (Approximate)
Required
Current Premium
Required
Do you require tenants to carry Renters Insurance?
Required
Please provide tenants name if you would like a renters quote for tenants?
Optional
Any other Information you would like to Share?
Optional
Other than premium reduction, what else is important to you?
Required
How did you hear about us?
Optional
Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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