RENTERS INSURANCE
Basic Address Information
Name
Address
City
State
Ca.
Zip:
Please supply either a Daytime or Evening Phone Number & best time to call.
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Evening Number:
Best Time To Call
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Request Renters Insurance
Dwelling Type
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House
Condominium
Apartment
# of Units in your Building
Year Built
Age of oldest resident
Deadbolts, Smoke Alarm Fire Ext.
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Yes
No
Non-Smoker
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Yes
No
Amount of Contents Coverage
Earthquake
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