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Renters

Personal information

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Are you a current client of Clay Paul Insurance?*

Full name*

Date of birth (mm/dd/yyyy)*

Mailing address*

Occupation

Phone number*

Email address*

Spouse/Roommate (name & DOB)

Your info is important to us!

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

Renters

Property information

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Address of the rental property*

Type of property

Presence of security system?

If yes, can you provide a monitoring certificate?

Your info is important to us!

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

Renters

Usage and occupancy

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

Your info is important to us!

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

Renters

Additional information

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Estimated Value of Personal Belongings (clothing, furniture, electronics, household goods, decor, etc)

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

Additional Interest - required Property Management information (if applicable)

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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