Current Quote Status
Started:
10/18/2017
Incomplete Provide Basic Information
Incomplete Generate Applications
Incomplete Submit For Binding Approval
Quote Look-Up
Cheyenna Sturgill

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If at any time you need assistance please contact Cheyenna Sturgill at 800-342-5572 or cheyennas@jsausa.com

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Dwelling (DP3) Quote


In order to give an accurate quote based on the most up-to-date rates for the effective period of your policy, please specify the effective date for this policy:

Applicant Name:
Agent Name:
Note: This is the name of the agent requesting the quote, NOT the agency name.
Agency Name:
Agency Phone:  -  - 

Please complete the following information to determine eligibility.

Please select one of these categories:
Is the unit occupied as student housing?  
 
If yes, is the unit occupied as a sorority or fraternity house?
 
 

City, Zip: ,
Year built:
Construction type:
Protection class:
Number of mortgagees:
Note: Individuals are not allowed. Only commercial lenders are acceptable.
Number of acres at this premises
Has the applicant been non renewed or cancelled during the last 36 months?  
 
If yes, please select the reason for non-renewal or cancellation:
Coverage A limit desired (Dwelling): $
Coverage C limit desired (Personal Property):

Protective devices (Please select all that apply).

None
Central Station Burglar and Fire

Working Smoke Detectors Throughout Dwelling
Sprinkler System In All Areas
Sprinkler System In All Areas Except Attics

Losses (last 36 months).

Personal Liability Losses:
Total Personal Liability Loss Amount: $
Medical Payment Losses:
Total Medical Payment Loss Amount: $
Property Losses (other than fire, theft, or flood):
Total Property Losses (other than fire, theft, or flood) Amount: $
Property Losses (fire, theft, and/or flood):
Total Property Losses (fire, theft, and/or flood) Amount: $