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Property Information Disclosure

Property disclosure sheet for new business.
"*" indicates required fields

Name*
First Last
Birth Date*
Month
Day
Year
Spouse's Name
First Last
Birth Date
Month
Day
Year
Mailing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Address of the property being insured*
Street Address City State / Province / Region ZIP / Postal Code Country
Name of your Mortgage Company if you have one
We need this information to send your mortgage company proof of replacement coverage and include their specific legal requirements.
Loan number
We need the loan number because your lender uses it to match the documents to your account.
Is your property insurance paid through an escrow account?
- Yes
- No
How do you hold title to this property?
Please list the legal name of any LLC, LP, or trust or individuals on the title in this line.
How are you using this property:*
If you use the property for Air B&B, seasonal rental, VRBO, or any business use, please let us know so we can advise you appropriately.
If this is a rental property, do you use a property manager?
Have you had any property insurance claims in the past 5 years*
- Yes
- No
Are there any dogs matching the description on the property?*
Pitbulls, Doberman Pinschers, Akita, Chow, Rottweiler, German Shepard, Wolf, Wolf Hybrid, any mix containing these breeds or any dog with a previous bite history are prohibited by most insurance companies.
- Yes
- No
Does the property have a pool?*
- Yes
- No
Is there a trampoline on the property?*
- Yes
- No
Select the deductible amount*
- $1,000.00
- $2,500.00
When would you like your new policy to start?*
Waiting for your renewal date is not necessary, we provide a pre-written cancelation notice to obtain a refund of the unearned premiumfrom your current insurance carrier.
Month
Day
Year
I acknowledge reading the disclaimer*
By submitting this form you are granting your permission for Rightway Insurance LLC to bind coverage based on a previously provided quote.
Failure to accurately answer the questions may result in the denial or cancelation of coverage by the insurance carrier. The insurance carrier reserves the right to verify that the property meets their underwriting guidelines.
Coverage is not effective until it has been approved by underwriting.
I agree
Post Custom Field

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1425 South Higley Road, Suite #107
Gilbert, AZ 85296

(480) 988-0878

1425 S. Higley Rd. Suite 107 Gilbert, AZ 85296

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