South Carolina Renters 1-85-JustRent

Contact Information

1. First and Last Name(required)
2. Birth Date(required)
3. Second Adult Occupant Name
4. Birth Date
5. Applicant Relation Single Married Married but Seperated Divorced Applicants Not Related No Second Applicant
6. E-Mail Address(valid email required)
7. Phone Number

Address to be Insured

1. Type of Home Home Apartment Condo Townhome Basement Apartment Dorm Garage Apartment
2. Street Number and Name
3. Unit or Apartment Number
4. City
5. State Please Choose South Carolina Georgia Alabama North Carolina Mississippi Tennesee Virginia
6. Zip
7. County
8. Less than 5 miles from the Coast?
9. Yes No

Current or Prior Address

1. What address did you have prior to moving to the "address to be insured"
2. Current Address
3. Current City
4. State
5. Zip

Other Occupant Info

1. Children?
2. Pets?

Home Information

1. Fire Sprinkler System in Unit?
2. Yes
   No
3. Dead Bolt Locks?
4. Yes
   No
5. Smoke Detectors
6. Yes
   No
7. Fire Extinguisher
8. Yes
   No
9. Security System
10. Monitored
    Alarm Only
    None
11. Gated Community
12. Yes
    No
13. Community 24 Hour Security
14. Yes
    No

Current Coverage

1. Type of Current Coverage None Home Condo Renters
2. Current Insurance Company
3. Any Claims in the last 3 years?
4. Yes
   No
5. Comment on Losses

Desired Coverage Amounts

1. Property Coverage Limit $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 $55,000 $60,000 $65,000 $70,000 $75,000 $85,000 $90,000 $95,000 $100,000 $105,000 $110,000 $115,000 $120,000 $125,000 $130,000 $135,000 $140,000 $145,000 $150,000
2. Desired Liability Level $100,000 $200,000 $10.00 more $300,000 $20.00 more
3. Medical Coverage Level $1,000 $2,500 $5.00 $5,000 $9.00
4. Desired Deductible $500.00 $1,000.00

Management or Complex Info

1. Complex or Prop. Mang. Co. Name
2. Leasing Agent Name
3. Phone Number
4. General Comments
5. Ten minus five equals
6. As part of the application process, we may collect personal information from persons other than you or other individuals proposed for coverage, including credit reports and loss information reports. This information, as well as other personal or privileged information subsequently collected by us, may in certain circumstances be disclosed to third parties without your authorization. You have a right of access and correction with respect to all personal information we collect. If you would like more detailed information in writing about our information collection practices, please let us know.
7. Agree

 

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