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    Hotel & Motel Program
    Insurance Quote Form
    One Simple Form - takes only 2-3 Minutes!


     
    Your Name:
    Business Name:
    Property Address:
    City:
    State:
    Zip/Postal:
    E-Mail (REQUIRED):
    E-Mail
    (again for accuracy):
    Phone:
    Fax (optional):
     
     
    Dwelling Information
     
    Year Building Built:
    Building Square footage:
     
    Occupancy: Motel Hotel
     
    Describe Facility Ammenities:
    (describe entities such as 26 unit motel with restaurant, pool, and jogging course, etc.)
     
    Type foundation: Slab
    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 4 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
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