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Landlord

Personal information

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Are you a current client of Clay Paul Insurance?*

Full name*

Date of birth (mm/dd/yyyy)*

Home address*

Occupation

Phone number*

Email address*

Spouse/additional owner (name & DOB)

Your info is important to us!

We’ll never share your information. For more details, view our privacy policy.

Landlord

Property information

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Address of the property*

Type of property

Date of purchase (mm/dd/yyyy)

Year roof was last replaced?

Can you provide proof of repair if asked?

Is the house under construction or major renovation?

Have plumbing, electrical, HVAC been updated?

If yes, what system & year

Presence of security system?

If yes, can you provide a monitoring certificate?

Have solar panels been installed?

Is there a pool, hot tub, or trampoline? (list)

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We’ll never share your information. For more details, view our privacy policy.

Landlord

Usage and occupancy

Primary use of the property (e.g., primary residence, rental property, vacation home)

Occupancy details (e.g., number of residents, pets)

Is the home vacant?

If yes, when do you expect it be occupied?

If not, when?

Your info is important to us!

We’ll never share your information. For more details, view our privacy policy.

Landlord

Insurance history

Current insurance carrier (if applicable)

Claims history (year, short description of damage, was repair completed)

Your info is important to us!

We’ll never share your information. For more details, view our privacy policy.

Landlord

Additional information

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Is the property a new purchase?*

If yes, what is the closing date? (mm/dd/yyyy)*

Will you pay the insurance directly or through your mortgage company?

Mortgage company name & loan number (if applicable)

When does coverage need to begin? (mm/dd/yyyy)

Your info is important to us!

We’ll never share your information. For more details, view our privacy policy.

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Phone

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