"Renter's Request for Quote Form"

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Renter's RFQ.doc - Google Docs
https://docs.google.com/document/d/1jf7C--8H5coE_HltGEc8m...
Renter’s Request for Quote Form
Effective Date ______
Name
Birth date
Education level
Occupation
Co-Applicant name, relationship, birth date, education level, occupation
Phone
Email
Address
SSN/Prior address is < 3 yrs
Dwelling Type – apt, condo, home
Personal Property Amount
Liability/Med Pay
Deductible
Scheduled property (appraised value items like jewelry…)
Year built
Type of siding
Sprinkler/Burglar &/or Fire Alarm System (local, central station reporting, direct)
Dog breed/bite history
Claims in the last 5 years (type, date, $)
________________________________________
By submitting this form, you acknowledge that we will be doing an insurance credit check which is required to
do a quote for you. This does not take points off your credit rating. This is not an application for insurance; it is
a request for a quote. We will get your quote to you or contact you for further information ASAP.
1 of 1
1/2/2016 8:59 AM
Renter's RFQ.doc - Google Docs
https://docs.google.com/document/d/1jf7C--8H5coE_HltGEc8m...
Renter’s Request for Quote Form
Effective Date ______
Name
Birth date
Education level
Occupation
Co-Applicant name, relationship, birth date, education level, occupation
Phone
Email
Address
SSN/Prior address is < 3 yrs
Dwelling Type – apt, condo, home
Personal Property Amount
Liability/Med Pay
Deductible
Scheduled property (appraised value items like jewelry…)
Year built
Type of siding
Sprinkler/Burglar &/or Fire Alarm System (local, central station reporting, direct)
Dog breed/bite history
Claims in the last 5 years (type, date, $)
________________________________________
By submitting this form, you acknowledge that we will be doing an insurance credit check which is required to
do a quote for you. This does not take points off your credit rating. This is not an application for insurance; it is
a request for a quote. We will get your quote to you or contact you for further information ASAP.
1 of 1
1/2/2016 8:59 AM