Building Insurance Questionnaire

First Name

Last Name

Email *

Phone *

Entity Name:

EIN#:

Mailing Address:

Property Address:

Year Built:

Construction type (Frame or Block):

Number of Stories:

Number of Buildings:

Sq Ft for each Building:

Roof type:

Number of Units:

Elevators:

Sprinklers:

Fire alarm:

Burglar Alarm:

Estimated gross rents:

Last updates made for electric/plumbing/roof:

Any major renovations done:

Losses in last 5 years:

Upload your Loss Run for last 4 years:

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