Application

Please take a moment to fill out the form below and one of our representatives will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

* Please complete the below application in its entirety.

(Defined as individuals under age 21 living in your house and holding a valid Driver's License.)
Enrollments are monthly beginning the 15th of each month.

Has any Member of your household had a major driving violation (i.e., DUI, Reckless Driving, etc.) or a license suspension in the past 3 years?

Do you own any rental properties?

Please check to confirm that you currently have (and will maintain) the Required Underlying Insurance.

By checking the box to the left, you verify that all of your representations on this application are true and accurate to the best of your knowledge.

Please check the box to the left to confirm that you have been advised by the originating insurance producer and you understand that this policy is underwritten by an Excess & Surplus lines insurer and that an Excess and Surplus lines insurer is not subject to the filing or approval requirements of the Department of Banking and Insurance. Such a policy may contain conditions, limitations, exclusions and different terms than a policy issued by an insurer granted a Certificate of Authority by the Department of Banking and Insurance.

By Checking this box you acknowledge that our policy includes coverage for one residential rental property. For coverage to be considered, the rental property must fit under our Policy's definition of "Tenant Property". Here is that definition: "Tenant Property" means a one, two, three or four family dwelling, including a condominium or cooperative in which you hold full legal title either as an individual or as a joint or common tenant with your spouse or "domestic partner" or hold in a trust you created for the purpose of transferring ownership to a family member, while rented to others.

Please click the "Submit Application" button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.

If you happen to own more than 1 rental property – please acknowledge in writing in the Notes section that you are aware that none of the properties are covered by this policy.

Send

Contact Insurance Specialists, Inc. Today

We Maintain Quality Benefits & Provide The Most Competitive Rates

Get in Touch Today