EmailMe Form - Hotel & Motel Program Insurance Quote Form

Name *
First Last
Business Name: *
Property Address:
City:
State:
Zip/Postal:
Email *
E-mail:
(again for accuracy)
Phone: *
### - ### - ####
Fax:
### - ### - ####
(optional)
Dwelling Information
Year Building Built:
Building Square footage:
Occupancy:
Motel
Hotel
Describe Facility Amenities:
(describe entities such as 26 unit motel with restaurant, pool, and jogging course, etc.)
Type foundation:
Slab
Second option Crawlspace over slab
Pier & Post
Other (list in remarks)
Type finished basement, if any:
None
Full
25%
50%
75%
Type Roof:
Shingle
Wood Shake
Tar/Gravel
Spanish Tile
Metal
Other
Type of Siding:
Brick
Vinyl
Wood
Aluminum
Number of stories:
One
Two
Three
Four or more
# of feet to nearest fire hydrant:
# of miles to nearest fire station:
Currently Insured?
Yes
No
Name of Carrier & how long insured?
Prior Claims?
Yes
No
Describe claims in detail:
Plumbing type:
Copper
Galvanized
Mixed (Copper/Galvanized)
Coverages:
Building Cov. $
Contents $
Liability Cov. $
Deductible $
($250, $500, $1,000, etc.)
Other Coverage/Remarks
(describe any extra coverages needed such as business interruption, robbery, computers, etc.):
Send my quotation via:
E-Mail
Fax
Regular Mail
Call Me by Phone
Thank you for filling out this form COMPLETELY!
Yes, I Agree. Please Send Me a Motel/Hotel Insurance Quote NOW!
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Dwelling Information

Coverages: