Tenant Quotation

Your Email Address (to receive a copy of your submission)

How did you hear about us? How did you hear about us? Referral I am a current client Media Ad Google Other

May we ask who referred you?

First Name

Last Name

Address

City

Postal Code

Main Phone

Ext.

Email Address

Date of birth

Occupation (Possible discounts)

Is there a co-applicant? Is there a co-applicant? Yes No

Co-applicant Full Name

What is the Co-applicants email?

What is the co-applicants Occupation?

What is the co-applicant's date of birth?

Is the residence... Is the residence... *Townhouse StyleApartment Style

Is the building.... Is the building.... *Wood Frame ConstructionConcrete / SteelUnknown

How many full and half bathrooms in the home? How many full and half bathrooms in the home? 1 1.5 2 2.5 3 3.5 Other

Please Specify

Do you currently hold any form of property insurance (Homeowner, Tenant, Condo, etc.)? Do you currently hold any form of property insurance (Homeowner, Tenant, Condo, etc.)? Yes No

How many years have you held property insurance of one form or another?

What is the name of your current property insurance company?

How many years have you been with your current company? How many years have you been with your current company? *12345 or more

Have you had any claims on your property insurance in the past five years? Have you had any claims on your property insurance in the past five years? *0123 or more

Please provide an approximate date for your claims(s) along with a brief description (hail, burglary, fire, etc.).

Do you rent any part of the home to others? Do you rent any part of the home to others? Yes No

Are there any smokers living in the home? Are there any smokers living in the home? Yes No

Are there any businesses operating from the home? Are there any businesses operating from the home? Yes No

What amount of contents coverage are you looking for?

Are there any special coverages you’re interested in?

Do you agree to Our Terms and Conditions? Do you agree to Our Terms and Conditions? I agree to the Touchstone Insurance Quotation Terms & Conditions