Condo Unit Owners Insurance
Condo Owners Insurance Application
(Quotes will be provided for Pennsylvania, New Jersey, New York, Maryland and Delaware)



Name:

Address:

City, State, Zip Code:

Phone:

Fax:

E-Mail:

Your age:

Construction of building:
County:
Is there public water available or fire hydrants within 1000 feet?Yes No
Occupancy - is condo:
Loss/claims history: Please state date, amount paid and details:
Do you engage in any work from the home to earn extra income? If so, please explain:
Alarmed:
Approximate market value:
Current insurance carrier:
Expiration date:
Premium paid:

Coverages
Personal property amount:
Personal liability:
Personal deductible:
Personal Medical payments:
Addition/alterations amount:
Replacement cost on contents included:Yes No
Unfortunately, many of the major insurance companies are checking credit reports as an underwriting guide into a person's tendency to submit condo insurance claims. There are studies that report a direct relationship to the way a person manages their money and claim submission. Normal condo maintenance repairs can prevent many claims from occurring. But if limited or no savings is available for ongoing repairs, the chances will increase for property damage to occur. We want to quote you with the best carrier that we can find who will not reject your application based on credit problems in the past.
Please rate yourself in terms of "paying bills on time":
Do you have a home based business to earn income?
If yes, please explain:
Do you have quotations from other companies?Yes No
Would you like a quote from us for the same coverage for easy comparison?Yes No
Who is the insurance company?
What specific coverages were quoted? (e.g., contents amount, liability amount, deductible options, etc.)
What was the price quoted?
How did you hear about us?
Additional Comments:

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