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Apartment Building
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!
 
Your Name:
Business Name:
Property Address:
City:
State: (Must be Pennsylvania)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail
(again for accuracy):
Phone:
Fax (optional):
 
 
Dwelling Information
 
Year Building Built:
Building Square footage:
Gross Annual Rents: $
 
Occupancy: Owner Tenant
 
Occupancy Type:
(describe entities & and number of units, such as "12 unit apartment" or "2 apartments, 2 offices and barber shop", or "4 apartments over a restaurant", etc.)
 
Type foundation: Slab
Crawlspace over slab
Pier & Post
 Other (list in remarks)
 
Type finished basement, if any: None Full
25% 50% 75%
 
Type Roof: Shingle Wood Shake
 Tar/Gravel Spanish Tile Metal Other
 
Type of Siding Brick   Vinyl
Wood   Aluminum
 
Number of stories: One Two
Three 4 or more
 
# of feet to nearest
fire hydrant: 		# of miles to nearest
fire station:
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
 

 
Coverages:
 
Building Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Other Coverage/Remarks
(describe any extra coverages needed such as business interruption, robbery, computers, etc.):
 
Send my quotation via: E-Mail Fax
Regular Mail
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Groninger Insurance . P.O. Box 48, 240 5th Street . Northumberland, PA 17857
Toll Free: 800-722-3743 | Local: 570-473-8107 | Fax: 866-672-6037
Our Telephone Hours are: 9:00am to 5:00pm (Monday-Friday)
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