Landlord Online Questionnaire

Do you think you pay too much for income property insurance?

Fill out our online form and submit it to our underwriters for consideration. The more exact your information is the more accurate a proposal we may return to you. Remember estimates are fine for a quick sample. However, if you wish us to design an actual policy for you we need exact information at that time.

Contact Information:

Name:
Email:
Mailing Address:
City:
State:
Zip:
Phone:

Property Information:

Your relationship to property to be insured:
Name(s) Property is deeded in:
Location Address:
The property is deeds with building(s) on it. For properties with additional buildings please enter detailed information in the additional information section below. The total square footage, as measured from the exterior, of the first building is . The basement area is and the attic area is , besides the basement and the attic there are only stories. The building is construction of the building is .

Year Built and Updates:

Year built:
Electrical system was updated year the amperage is and the electrical system still operating is .
Heating system year of update is the fuel is . Is there a solid fuel heating source? (wood, pellet, corn, or coal stove)
Roof year of replacement . The roof material is
Plumbing is made of and the most recent hot water heater replacement or system update is

Occupancy(ies):

The occupancies of the building are as follows apartments totaling square feet, mercantile totaling square feet, offices totaling square feet and the following additional types of occupancies are . Besides apartments, there are rooms for roomers. There are rooms for roomers or apartments that are, will, or may be rented to students without their families. (Students for this question are high school, college, or university students. Yes, grad students count as students.)

Other Location Considerations:

The breed of dogs or other animals at the location include .

Do you have your tenants sign leases or rental agreements for 6 months or more? Are they required to have renters insurance and do you keep a copy of proof they have purchased it?

Protection, Life and Property Safety:

The closest fire department is .
The closest fire hydrant is
There are

Coverage Information:

Desired Deductible:
Highest Deductible I will consider is:
Building Coverage:
Business Personal Property Coverage:
Liability Coverage:

Prior Insurance Information:

Is the property currently insured?
If no, why?
If yes, is the policy in cancellation status?
If the policy is in cancellation status, explain why.
Name of insurance company insuring the property now annual premium estimated

Loss information:

Have you had a loss at or on any property that you have had a financial interest in within the last 5 years?
If yes, explain what happened, where it happened, when it happened, and how much was paid out
Was the loss at the property you wish insured?

Note: When you complete this for you will be redirected from our form server back to our Landlord Insurance web page. Thank You!

For more information and to find out if your tenant occupied property qualifies for the insurance policies we have found please contact us insurance@drickardinsurance.com or 607-843-8860.

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All prices, programs, features, underwriting, offers, representations and companies shown in this site are subject to change without notice. We may add or discontinue a company or program or an insurer may change underwriting criteria or product line availability without notice to us. With the insurance industry constantly changing we may not be able to keep the site up with the latest information. For the up to date info please contact us. All insurance applications are always subject to current underwriting rules, acceptance of the insurer and adequate premium paid.