If available, enter the Reference # at the top right of the mailing

City

Zip

Mailing Address
How is the home used?

Owner lives in the home 9 months/year

Owner lives in the home less than 9 months/year

Owner rents the home to an annual tenant

Owner rents the home on a short-term basis (e.g. AirBnb, VRBO)

The home is vacant

Does the home have a swimming pool?

Yes

No

Does the home have solar panels?

Yes

No

How many units are in your building? Based on your HOA master insurance, which insurance does your unit require?

Condo Policy
(Drywall-In Coverage)

Dwelling Policy
(Full Structure Coverage)

Unsure
I will ask the HOA.

How many units are in your building? How many stories are there in the building? What story is your unit on?

Please enter any info you can about the number and types of your pets

Is this home a new purchase?

Yes

No

Please provide any details you can.

Please provide any details you can.

Co-Applicant's First Name Co-Applicant's Last Name Co-Applicant's Date of Birth Has your co-applicant ever served in the US military?

Yes

No

Gender

Male

Female

None

Marital Status

Single

Married

Language

English

Spanish

Other

What is the best email to reach your co-applicant? What is the best phone number to reach your co-applicant? May we contact your co-applicant via SMS/text?

Yes

No