Phone: 425-775-7651 Toll Free: 866-277-7651
 
Renters and Condo Insurance for Washington State

 
Name : Daytime Phone :
Date of Birth : Evening Phone :
Address : Best Time to Call :
City : Email Address :
State : Social Security # :
Zip Code :    
If your company qualifies for a group discount please include your company name here :
 
Are you currently Insured?
If married, spouse's name and date of birth
Yes No
Type of quote you would like to receive

Any homeowners claims in the last 5 years? (if yes, please give details in comments section)
Tenant/Renter Condominium

 Yes No
Select the type of building you live in Current Insurance Company:
Apartment Building Condominium
House  


What is the construction of your building?

Contents coverage desired. $20,000 is the minimum.
Wood Frame Brick
Do you own the unit you live in? Liability Coverage
Yes No
$100,000 $300,000
$500,000  
Number of units or families in the building
Select all safety features that apply:
Dead Bolt Locks Fire Extinguishers
Fire Alarm (in building) Fire Alarm (central station)
Smoke Detectors (hard  wired) Burglar Alarm (in building)
Smoke Detectors (battery) Burglar Alarm (central station)
One Three
Two Four or more
Other types of insurance you currently have:
None Life
Automobile Long Term Care
Business Boat
Use this box to provide additional information:

 
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