This field is hidden when viewing the formBroker NameThis field is hidden when viewing the formBroker Email This field is hidden when viewing the formClient Name First Last This field is hidden when viewing the formClient PhoneThis field is hidden when viewing the formClient Email This field is hidden when viewing the formNeed By / Expiration Date MM slash DD slash YYYY Landlord ApplicationFor single locations with 1 to 4 units.Legal Entity NameDBAEntity TypeSelectIndividualCorporationLimited Liability Company (LLC)TrustOtherDoes this entity hold or own more than one property?First ChoiceSecond ChoiceThird ChoiceWebsiteFEINCurrent CarrierMailing Address Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code OperationsYear Business StartedYear Business StartedHow many years of experience do you have?Any short-term rentals less than 12 months?SelectNoYesEstimated Annual Rent Roll / RevenueIs there an Additional Interest/Lienholder?SelectYesNoOccupancy RateAre tenants required to carry renters' insurance?SelectYesNoHow is the location managed?Self Managed3rd Party ManagementWhat is the name of the property management company?How many years have they managed the property?Annual payroll for property manager: Property InformationAddress to Insure Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Number of UnitsSelect1 (Single Family)2 (Duplex)3 (Triplex)4 (Quadplex)Do you occupy one of the units of this location?SelectYesNoIs there a lienholder on the property?SelectYesNoYear BuiltTotal Square Footage of BuildingEstimated Building Replacement CostBased on the rebuild cost per square foot, determined by the location of the property.What is the value of contents owned by you?This includes furnishings and personal belongings.Number of StoriesSelect1 Story2 Stories3 Stories4 StoriesNumber of BedroomsNumber of BathroomsNumber of garage or parking spaces:Construction TypeSelectWood FrameBrick Veneer / MasonryConcreteSteelLogOtherNot SureRoofing TypeSelectCompositeFlatTileSlateAsphaltMetal / TinWoodTar / GravelNot SureAny fences, landscaping, or detached buildings?YesNo Safety & SecurityDoes the location have a fire alarm?Please ChooseYesYes, and reports to fire department.NoIs the building interior sprinkled:Please ChooseFull SprinkledPartially SprinkledNot SprinkledIs the building exterior sprinkled:Please ChooseFull SprinkledPartially SprinkledNot SprinkledDoes the location have a pool?Please ChooseNoYes, fencedYes, not fencedAre tenants permitted to have dogs?Please ChooseNo dogs allowed.Yes, all dogs welcome.Yes, small dogs only.Any old or outdated electrical wiring or panels like Zinsco, Stab-Loc, or aluminum?Please ChooseNoYes Property UpdatesRoof Updates No Update Partial Update Complete Update Year and brief description of roof updates:Electrical No Update Partial Update Complete Update Year and brief description of electrical updates:Plumbing Updates No Update Partial Update Complete Update Year and brief description of plumbing updates:HVAC / Mechanical Updates No Update Partial Update Complete Update Year and brief description of HVAC / mechanical updates:Water Heater Updates No Update Partial Update Complete Update Year and brief description of water heater updates: Property MaintenanceProperty Maintenance As Needed Contracted 24/7 Parking & Walkway Condition Fair Normal Recently Paved HVAC Service Every 12 months Within the last 24 months Over 24 Months Ago Plumbing Service Every 12 months Within the last 24 months Over 24 Months Ago Have you had any policy cancellations in the last 5 years?SelectNoYesAny insurance claims in the last 5 years?If there is any coverage within the last 5 years, we will need a copy of the official Loss Runs, regardless of loss history. SelectYesNo Δ