Landlord Insurance

Contact Information

Name *

First

Last
Date of Birth

MM
/
DD
/
YYYY
Gender
 Male 
 Female 
Multiple Choice
 Single 
 Married 
Occupation
Phone *

###
-
###
-
####
Email *
Best day to contact
Best time to contact

Property/Home Details

Approximate Year Built
Approximate square footage
Do you own or rent your primary residence?
 own 
 rent 
Do you live in this property?
 yes 
 no 
Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Property Type
Exterior Walls
Roof Type
Primary Heating System
Number of Bedrooms
Number of Bathrooms
Number of Stories
Garage Type
Is your building/property managed by a Licensed Property Management agent?
 yes 
 no 
Is your building/property part of a Strata title place?
 yes 
 no 
Fire Alarm
Security system
What quantity of contents do you have?
 fixtures and fittings only  
 furniture & major appliances in addition to fixtures and fittings  
 fully furnished including bedding and kitchenware as well as fixtures and fittings 
 average - no name brands, basic equipment, self-assembled furniture, etc. 
 quality - well-known brands, superior equipment, standard furnitures, etc. 
 prestige - designer brands, handcrafted furniture, etc. 
List any additional features in your property (ex. Grage, swimming pool, etc.)

Coverage

Liability Protection
Deductible
Personal Property
Loss of Use
Comments

Contact Information

Our Location

321 5th Street
Huntington Beach California, 92648

pen

Toll Free: 888-467-1718
Fax: 714-536-0599
email: gabe@wrinsurance.com