Renters Insurance

For California residents only.

Just How Safe Are Your Belongings?

Someone's home is being burglarized every 10 seconds!

After you've completed this form, click on the SUBMIT button to receive your free Renters Insurance quote. You'll be given an opportunity to specify U.S. Postal Service, e-mail or fax. Or phone (760) 644-0351.

Customer Information
Name
E-mail
Street address
City
County
State
Zip Code
Home Phone
Work Phone
FAX

Apartment Building Description
Number of Units in Bldg.	Age 55 & Retired	Inside City Limits?	Central & Alarm Systems (Select all that apply)
	Yes No	Yes No	Smoke Alarms Fire Extinguisher Dead Bolts 24 Hour Guard Central Station Burglar Alarm

Requested Coverages
Value of Contents (Minimum $23,000)	Liability	Deductible	Earthquake Cov. Wanted?
	-- select -- $100,000 $300,000 $500,000 $1,000,000	-- select -- $500 $1,000	Yes No

Do you have any Jewelry, Fine Arts, Sporting Equipment or Collections which may need special "ALL RISK" Coverage?

Underwriting Information
Marital Status:	-- select -- Single Married - BOTH Work Married - 1 Stay at Home
Current Insurance
Expiration Date
Breed of Dogs?
Losses within the last 5 years?

Reporting Method
How would you like to receive your free Renters Insurance quote?	U.S.Postal E-mail Fax

 

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