STIA - Condo

Primary Insured

First Name

Last Name

Phone Number

Mailing Address

Property Location Address

City

State

Zip

Property Information

Property Location Address

City

State

Zip

How Many Stories:

1 Story, 1.5 Stories, 2 Stories, Split-Level, Other (please specify)

Construction Type:

Wood, Stucco, Masonry, Brick Veneer, Other (please specify)

Primary Residence?

Yes or No

How Many Units:

1, 2, 3, 4, 5+ (If more than 5, please specify)

What type of building is this?

Apartment, Condo, Townhouse, House, Manufactured/Mobile Home

Other Features:

Deadbolts, Smoke Detectors, Fire Extinguisher, Central Station Fire and/or Burglar Alarm, Swimming Pool, Trampoline, Other (please specify)

Coverage Information

Carrier Name

Policy Number

Expiration Date

Current Coverage Limits

Current Deductible

Desired Coverage

Deductible

Amount of Liablity Desired

Is your home older than 20 years? If so, what updates have been done?

Claims?

Date of Claim

Amount Paid

Claim Type

Description

Date of Claim

Amount Paid

Claim Type

Description

Additional Information

** Please Note: Coverage cannot be bound via this quote request form. **

Condo Insurance Quote Request