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Commercial Property Insurance Quote
Policy Holder Information
Legal Entity Name
Business Name / dba
Please provide a brief description
of the nature of your business
Mailing Address
City, State and Zip
Telephone Number
Fax Number
E-Mail Adddress
Estimated Annual Gross Sales/Rents

 

Property Coverage Information
Physical Address
City, State and Zip
Name and Telephone of Person
to Contact for Inspection
Square Footage of Building
Construction Type
Does Building have a Central Station Alarm?
Replacement Cost of Building
Replacement Cost of Contents
Desired Deductible Amount

 

Location #2 Coverage Information (if more than one location)
Physical Address
City, State and Zip
Name and Telephone of Person
to Contact for Inspection
Square Footage of Building
Construction Type
Does Building have a Central Station Alarm?
Replacement Cost of Building
Replacement Cost of Contents

 

Property Update Information
Date of latest roof
upgrade or repair work
  Location 2
Date of latest electrical
upgrade or repair work
  Location 2
Date of latest plumbing
upgrade or repair work
  Location 2
Year originally built   Location 2

 

Lienholder Information
Will a Landlord/Owner be named as Loss Payee?
Name of Landlord/Owner
Mailing Address
City, State, Zip

 

Other Information
Any claims in the past 3 years?
If yes, please provide the number of prior claims and amount paid for each.

 

Portions courtesy of and © Insurance Information Institute (www.iii.org) Copyright © 2001-2016 Aloha Insurance Services, Inc. Kona HI All rights reserved.
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