Apartment Bldg. Quote 
Dwelling Fire/Apartment Building Insurance Quote

Name of Business:
Contact Name:
Address:
City:
State: Zip:
Business Phone:
Fax Number:
Contact Email Address:
Property Information
Address of Property:
Property City:
Property State:
Property Zip:
New purchase Existing ownership
Number of units:
Building Square footage:
Year Built:
Occupancy:
Owner Tenant
Occupancy Type:
Plumbing type:
Copper Galvanized Mixed (Copper/Galvanized)
Foundation Type:
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:
1 2 3 4 or more
# of feet to nearest fire hydrant:
# of miles to nearest fire station:
Currently Insured?
Name of Carrier & how long insured?
Yes No
Coverage's
Building Coverage
$
Liability Coverage
$
Contents
$
Deductible $
($250, $500, $1,000, etc.)
$
Other Coverage/Remarks:
(describe any extra coverage's needed such as business interruption, robbery, computers, etc.):
Any claims reported on this property or previously owned properties in the last 3 years?
Yes No
Please describe: Include date(s) and details of claim:

Additional Comments
Please give any additional comments or questions

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Mark Chaffee
Mortgage Financial, Inc.


“When I switched my home and auto coverage to Winooski Insurance, they didn’t just try to sell me the same policy. They asked me the right questions to get me better coverage, while saving me money. I feel confi dent that they shop the best price for me each year.”

Sue Gosselin
Colchester, VT.


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