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JERRY BREWTON
Licensed Agent, Author,
Speaker & Insurance Educator

   
Apartment Building
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


 
Your Name:
Business Name:
Property Address:
City:
State:
Zip/Postal:
E-Mail (REQUIRED):
E-Mail
(again for accuracy):
Phone:
Fax (optional):
 
 
Dwelling Information
 
Year Building Built:
Building Square footage:
Number of Units:
Gross Annual Rents: $
 
Occupancy: Owner Tenant
 
Occupancy Type:
(describe entities & and number of units, such as "12 unit apartment" or "2 apartments, 2 offices and barber shop", or "4 apartments over a restaurant", etc.)
 
Building Exterior Wall Construction: Frame
Masonry
Other (list in remarks)
 
Smoke Detectors in Common Areas? Yes No
 
Smoke Detectors in Individual Units? Yes No
 
Sprinkler System in Building? Yes No
 
Type Roof: Shingle Wood Shake
Tar/Gravel Spanish Tile Metal Other
 
Type of Siding Brick   Vinyl
Wood   Aluminum
None
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
Number of stories: One Two
Three 4 or more
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
Swimming Pool On Premises? Yes No
 
Building Occupied by Full-time Students? Yes No
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:

 
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.):
 
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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.

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Cities in Indiana, Michigan, and Tennessee that we service: INDIANA: Anderson, Angola, Auburn, Avon, Bedford, Beech Grove, Bloomington, Bluffton, Brazil, Bremen, Brownsburg, Carmel, Chesterton, Churubusco, Cicero, Columbia City, Columbus, Connersville, Crawfordsville, Crown Point, Decatur, Elkhart, Evansville, Fishers, Fort Wayne, Frankfort, Franklin, Fremont, Garrett, Gary, Goshen, Greencastle, Greenfield, Greensburg, Greenwood, Griffith, Hagerstown, Hammond, Hobart, Huntertown, Huntington, Indianapolis, Jasper, Jeffersonville, Kendallville, Knox, Kokomo, Lafayette, LaGrange, LaPorte, Lebanon, Ligonier, Logansport, Marion, Merrillville, Michigan City, Middlebury, Mishawaka, Monticello, Muncie, Munster, Nappanee, New Albany, New Haven, Newburgh, Noblesville, North Manchester, Orleans, Peru, Plymouth, Portland, Rensselaer, Rochester, Schererville, Seymour, Shelbyville, Sheridan, Shipshewana, South Bend, Southport, Speedway, Syracuse, Terre Haute, Valparaiso, Vincennes, Wabash, Warsaw, West Lafayette, Westfield, Winamac, Zionsville, MICHIGAN: Ann Arbor, Petosky, Jackson, Battle Creek, Saginaw, Three Rivers, Kalamazoo, Portage, St Joseph, Niles, Edwardsburg, Flint, Muskegon, Big Rapids, Traverse City, TENNESSEE: Knoxville, Nashville, Memphis, Farragut, Sevierville, Pigeon Forge, Johnson City, Cleveland, Chattanooga