Your Name * First Name Last Name Your Phone * Please share the best phone number for contacting you. (###) ### #### Your Email * Your Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Property Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Property County * Occupancy Type * Rental Rehab (Builders Risk) Rehab Type If Rehab, is it Major (moving load-bearing walls or adding square footage) or Minor (cosmetic)? Major Minor Building Type * Single Family Residence 2-4 Unit Condo Townhouse Construction Type * Brick Veneer Joisted Masonry Wood Frame Unknown Square Footage * Monthly Rent * Would you like coverage for loss of rental income? If so, how much per month? If not, please write N/A. Number of Units * Year Built * Year of Most Recent Plumbing Renovation (If Known) Age of Roof in Years (If Known) Lender / Additional Insured Info * Is this entity a lender, additional insured or loss payee? Select all that apply. Lender Additional Insured Loss Payee N/A Is the insurance escrowed? * Yes No Name of Lender / Additional Insured Address of Lender / Additional Insured Address 1 Address 2 City State/Province Zip/Postal Code Country Loan Number Lender Email Thank you! A SUR team member will be following up with you shortly to review coverage options and a quote!
