800 W Williams Street, Suite 231-C
Peakway Market Square
Apex, NC 27502
(919) 267-3063

ABC Insurance Agency is only licensed in the state of North Carolina.

RENTERS QUOTE FORM

ALL FIELDS ARE REQUIRED FOR AN ACCURATE QUOTE

How did you hear about this website?  

Name:               Date of Birth:  
Name2:              Date of Birth:  
Street Address:   
City, State Zip:  , 

If Less Than 3 Years
Previous Street Address:  
Previous City, State Zip: , 

Number of apartment in row or building.   

Phone Number: 
Email:        

Current/Previous Homeowners or Renters Insurance Company: 

How many homeowners claims have been filed on an insurance policy that you were a named insured? 
Explain Above: 
               

Appox Square Footage? 
Number of Bedrooms?   
Number of Bathrooms?  
Number of Half Baths? 

How much personal property coverage do you need? 
     This brochure may be helpful in determining coverage needed. Home Inventory Form

Do you have any personal property in a storage unit? 
      
      Yes
      No
    
If so, where is this located? 

Burglar Alarm?  
      
      None
      Local
      Central Station
    
Fire Alarm?     
      
      None
      Local
      Local
      Central Station
    
Does the building have a fire sprinkler system?  
      
      No
      Yes
    

Deductable?   
      
      $100
      $250
      $500
      $1,000
      $2,500
    


OTHER COVERAGES
Do you currently have Sewer and Drain Backup coverage?    
      
      Yes
      No
    
   Would you like more information about this coverage?   
      
      Yes
      No
    

Do you currently have Identity Theft Recovery coverage?   
      
      Yes
      No
    
   Would you like more information about this coverage?   
      
      Yes
      No
    

What company currently insures your vehicles? 
Are you also interested in an auto quote?     
      
      Yes
      No
    
     (a multi policy discount on your auto may be enough to pay for this policy) 

Do you currently have a Personal Umbrella Policy?         
      
      Yes
      No
    
   Would you like more information about this policy?     
      
      Yes
      No
    

Are there any items such as jewelry or collectable that need to be listed seperately or scheduled?
  (Renters policies are a "Name Peril" type policy so you may want to concider covering valuable jewelry or
  collectables on a policy called a "Inland Marine" or "Floater")
      
      



Best Time to Reach You: 
      Morning (8:30 am - 12:00 pm)
      Afternoon (12:00 pm - 4:30 pm)
      Evening (4:30 pm - 8:00 pm)
    

Comments  


By saying "YES" in box to the right I give consent to order a credit based insurance score. 
If any other answer than yes appears above, a quote will not be complete.

Phone: 919.267.3063
Fax: 866.453.9992
E-mail: agency@abc-insure.com

Address:
ABC INSURANCE AGENCY
800 W. Williams St, Suite 231-C
Apex, NC 27502