Condo Insurance Request

* Required Fields

Name:*
Property Address:
City:*
State:* IL IN WI	Zip:*
County:*
Home Phone:
Bus. Tel:
E-Mail:*
Are you currently insured?* Yes No
Current personal property coverage amt.: $
Condo Information
Year built:*	No. of units in your building:*
Type of construction:* Brick Frame Fire resisitive (concrete floors & ceilings)
Desired personal property cov.:* $
Deductible:* 250 500 1000
Alarm: smoke/fire/burglar local/central
Business on premises: Yes No
If so, what kind:
Scheduled personal property: $ Jewelry $ Furs $ Silver $ Other
Please describe any additional coverage:
Please describe any losses last 3 years:
Additional comments that may effect outcome of request:
If you would like to talk to a representative regarding any questions on this questionnaire, or an insurance request for something other then you see on our Web site, call our toll-free direct line at 877-627-7808 and we can take your insurance information directly over the phone. Equity Insurance Agency works directly with independent insurance carriers to get you the best rates with "A"-rated companies with excellent claims and customer service.