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Independent Insurance Agent
H&K Renters Quote Form

We would like to provide you with a free, no-obligation condominium insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Important Note: We will need to review the insurance section of your condominium association's by-laws to provide you with the proper building coverage.

Personal Property Calculator Click here for an online personal property calculator to estimate the value of the contents of your dwelling.

Personal Information
Name:
Main Insured's Soc. Sec. #:
Address:
City: State: Zip:
 
Property Address
(if different from above):
City: State: Zip:
 
Day Phone: Night Phone:
Best Time To Call: AM PM
Email Address:
Occupation: How Long At Current Job:
Date of Birth: Smoker ?: Yes No


Current Insurance Information
Company Name (not agency):
Policy Expiration Date: Premium Amount: $
Amount Insured For: $ Policy Type: Primary Secondary
Term: 6 Months 1 Year Other:
Have you filed any property
claims in the past 3 years?: 		Yes No

If "YES", please give us claim details below:


Dwelling Information
Living Area Sq Ft:
Number of units in your building:
Year Built:
Copper Plumbing?: Yes No
Circuit Breakers?: Yes No
Alarm System:
Is the home/apartment equipped with at least one working smoke alarm?: Yes No
Does your home have at least one fire extinguisher that is 2 1/2 lbs. or larger?: Yes No
Do all exterior doors have deadbolt type locks?: Yes No


Desired Coverages
Deductible: Comprehensive Personal Liability: Value of your Contents:
$
List any additional coverage requirements below:


Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have
additional information where there was not enough space, please enter them here.


Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.


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