Renter's Information:
Name:
Email:
Address:
Age of building, or of house:
How many units in apartment building:
Roof Type:	Flat Roof Shingle Roof
Personal property coverage:	100,000 300,000 500,000
Deductible:	200 500 1000
Personal liability:
Medical coverage:	1,000 5,000
Jewelery:	Yes No
Contents:
Own or Rent?	Own Rent
Any claims in the last three years?	Yes No
At this time do you need to add a spouse or room-mate to your policy?
Name: