Property Address (include city and zip):
Mailing Address (if different):
Date of Birth:
Mobile/ Manufactured/ Modular home
Do you have a current renters policy:
Any dogs live in the home:
If yes, please specify quantity and breed:
List any unusual or exotic pets:
List any unique features of home:
Is it a gated community:
Is there a 24 hour security guard shack at the entrance or a 24 hour security patrol that drives around:
Central Station Alarm:
Any home claims in the last 3 years:
Do you have any workers in the home (caretaker, housekeeper, nanny etc.):
If yes, approximate hours per week:
In home business which creates foot traffic to your home?
Is there a fire station within 5 miles and a fire hydrant within 1000 feet:
Renter insurance comes with $40,000 in contents. If you would like more, please list amount:
Earthquake and flood are never covered under a home policy but can be written separately. Would you like a free quote?
Any questions or comments?
Doctor & Doctor Insurance Agency
10216 Reseda Blvd, Northridge, CA 91324
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