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Landlord's Insurance Quote Request Form One Simple Form - takes only 2-3 Minutes!   Your Name: Business Name: Property Address: City: State: (Must be Georgia) Zip/Postal: E-Mail (REQUIRED): E-Mail (again for accuracy): Phone: Fax (optional):     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 Thank you for filling out this form COMPLETELY! We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy. Yes, I Agree. Please Send Me a Landlord's Insurance Quote NOW! Click Button Below When Done Please Click Only Once . . . May take up to 30 seconds!

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