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Landlord Quote form
Contact Information
Name
Date of Birth
Preferred Quote Delivery
Phone
Email
Call-Back Phone Number
Email Address
Current Street Address (Not property to be insured)
Address
Address Line 2
State
-- Select a State --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
Information of Property to Be Insured
Address
Address Line 2
State
-- Select a State --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
Year Built
Building Material
Masonry
Siding
Stucco
Roof Material
Material Composition
Wood
Metal
Total Living Area (Square Feet)
Number of Stories
-- Select --
1
1.5
2
2.5
3
Number of Bathrooms
-- Select --
1
1.5
2
2.5
3
3.5
4
4.5
5
Garage
-- Select --
1-Car Attached
2-Car Attached
3-Car Attached
Detached
Carport
Foundation
Slab
Crawlspace
Basement
Type of Fireplace
Gas
Traditional
None
Type of Air Conditioning (check all that apply)
Central
Window-Unit
Attic Fan
None
Other
Type of Heating (Check all that apply)
Gas
Propane
Electric
Floor Furnace
Wall Furnace
Wood Stove
None
Other
Type of Electric
Circuit Breakers
Fuse Box
Type of Plumbing (Check all that apply)
PVC
Copper
Cast Iron
Other
Year Roof Was Last Replaced
City Limits
Inside
Outside
Nearest Fire Hydrant
Under 1000 ft
Over 1000 ft
Nearest Responding Fire Department
-- Select --
1
2
3
4
5
6
7
8
9
10+
Swimming Pool
Yes
No
Fence Around Pool
Yes
No
Diving Board
Yes
No
Slide
Yes
No
Dogs
Yes
No
If yes, how many and what breed(s)
Coverage Information
Coverage Requested for Dwelling
Coverage Requested for Landlord Furnishings
Yes
No
If yes, how much
Coverage Requested for Liability
-- Select --
$100,000
$300,000
$500,000
Desired Deductible
-- Select --
500
1000
2000
An claims in the last 3 years at this property?
Yes
No
If yes, explain
Additional comments to your agent
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(405) 293-4880
2403 S. Division St.
Suite A
Guthrie, OK 73044