DWELLING RENTAL WEB QUOTE

1
TELL US ABOUT YOU
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2
WHAT DO THEY CALL YOU* This field is required
First Name
Middle Initial
Last Name
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3
WHERE CAN WE SEND THE MAILJust start typing we'll do the rest try its fun and easy
Street Address
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City
State / Province
Postal / Zip Code
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Myanmar
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Namibia
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Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
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Palau
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Panama
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Paraguay
Peru
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Poland
Portugal
Puerto Rico
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Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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4
THE DAY YOU WERE BORNTell us the date
MM/DD/YYYY
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5
GENDER
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6
MARITAL STATUS:
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7
EMPLOYMENT:
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8
OCCUPATION:
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9
E-MAIL:* This field is required
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10
HOME PHONE:
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11
CELL PHONE:
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12
ADDITIONAL NOTES:
For office use only
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13
LEAD SOURCE:
Where did you hear about us
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14
REFERRAL NAME:
Enter the name of the person who told you about PRL
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15
PROPERTY ADDRESSJust start typing we'll do the rest its fun
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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16
IS THE PROPERTY CURRENTLY OCCUPIED:
YESNO
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17
PURCHASE DATE:
MM/DD/YYYY
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18
MORTGAGE & TITLE INFORMATION
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19
IS THERE A MORTGAGE ON THE PROPERTY?
Yes
No
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20
How many
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21
MORTGAGE NOTES
For office use only
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22
NAME(S) ON THE TITLE OF THE HOUSE
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23
IS THE HOME IN A TRUST OR LLC
Yes
No
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24
TRUST OR LLC INFORMATION
If LLC, how many members in the LLC please list them by name
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25
WILL THERE BE A PROPERTY MANAGEMENT COMPANY
Yes
No
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26
DOES THE PROPERTY MANAGEMENT COMPANY NEED TO BE NAMED AS ADD'L INSURED?
Yes
No
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27
PROPERTY MANAGEMENT COMPANY INFORMATION
Include name address and contact person
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28
WILL YOU REQUIRE THE TENANT TO CARRY RENTERS INSURANCE?
Yes
No
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29
IS THERE A LEASE AGREEMENT?
Yes
No
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30
How many months is the lease agreement
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31
ADDITIONAL PROPERTY NOTES
Office use only
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32
DO YOU HAVE LIFE INSURANCE TO COVER YOUR MORTGAGE?
Yes
No
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33
LIFE INSURANCE NOTES:
Office use only
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34
DOES YOUR DESCRIBED ADDRESS INCLUDE MORE THAN 1 TAX LOT?
Yes
No
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35
TAX LOT INFORMATION
Please describe additional tax lot situation
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36
IS THE PROPERTY LOCATED BY WATERFRONT?
Yes
No
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37
WATERFRONT NOTES
Describe the property and location in regards to the waterfront
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38
DO YOU WANT FLOOD INSURANCE?
Yes
No
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39
DOES YOUR MORTGAGE LENDER REQUIRE IT?
Yes
No
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40
IF NEW PURCHASE, DO CURRENT OWNERS HAVE IT?If yes often we can transfer from current owners to new owners.
Yes
No
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41
FLOOD INSURANCE NOTES AND COMMENTS
For office use only
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42
DO YOU WANT EARTHQUAKE (EQ) INSURANCE?
Yes
No
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43
EARTHQUAKE NOTES AND COMMENTS
Office use only
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44
DO YOU WANT LANDSLIDE INSURANCE?
Yes
No
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45
LANDSLIDE INSURANCE NOTES
Describe the situation slope, water problems etc.
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46
PROPERTY NOTES
Office use only
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47
IS THERE A CO-APPLICANT?:
No
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48
CO-APPLICANT
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49
NAME:
First Name
Middle Initial
Last Name
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50
BIRTH DATE:
Date
Month
Day
Year
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51
GENDER:
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52
MARITAL STATUS:
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53
EMPLOYMENT:
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54
E-MAIL:
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55
APPLICANT RELATION:
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56
DWELLING INFORMATION
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57
NUMBER OF FAMILIES:
1
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58
YEAR BUILT
YYYY
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59
YEAR BUILT:
Please Select
Please Select
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
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60
CONSTRUCTION:
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61
OCCUPANCY STATUS:
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62
RESIDENCE TYPE:
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63
CIRCUIT PANEL:
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64
COURSE OF CONSTRUCTION:
Yes
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65
DWELLING NOTES AND COMMENTS
Office use only
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66
FIRE PROTECTION
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67
IS THE DWELLING WITHIN THE CITY LIMITS:
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68
DISTANCE FROM NEAREST FIRE STATION:
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69
IS THE DWELLING WITHIN 1000 FT. OF A FIRE HYDRANT?
Yes
No
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70
CONSTRUCTION AND HOME FEATURES
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71
OVERALL FEATURES OF THE STRUCTURE (GRANITE VS TILE, HARDWOOD FLOORS VS CARPET, WHITE APPLIANCES VS STAINLESS, ETC. PERCENTAGE BREAKDOWN (I.E. 50% CARPET, 30% HARDWOOD FLOORS, 20% VINYL FLOORS)
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72
TOTAL LIVING AREA (SQ FT) NOT INCLUDING BASEMENTS OR ATTICS:
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73
DOES THE DWELLING HAVE A BASEMENT?
Yes
No
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74
HOW MANY SQ FT FINISHED
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75
HOW MANY SQ FT UNFINISHED
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76
IS THERE A SUMP PUMP
Yes
No
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77
BASEMENT NOTES:
Is it finished, unfinished, walkout etc
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78
DOES THE DWELLING HAVE AN FINISHED ATTIC?
Yes
No
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79
HOW MANY SQ FT?
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80
DOES THE DWELLING HAVE A DECK?
Yes
No
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81
NUMBER OF DECKS
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82
DECK COMPOSITION
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83
STYLE OF DWELLING:
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84
NUMBER OF STORIES:
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85
DOES THE DWELLING OR DWELLINGS HAVE A GARAGE OR CARPORT
Yes
No
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86
PLEASE DESCRIBE
Detached, carport, detached garage etc.
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87
GARAGE TYPE:
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88
HAS THE ROOF BEEN REPLACED?
Yes
No
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89
WHEN WAS IT REPLACED?
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90
FOUNDATION TYPE:
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91
BASEMENT % FINISHED:
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92
DAYLIGHT BASEMENT:
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93
LAND SLOPE
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94
FOUNDATION AND LAND SLOPE NOTES
Office use only
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95
BATHROOM AND KITCHEN

FULL BATH = 3+ FIXTURES (TOLIET, SINK AND BATHTUB), 3/4 BATH = 3 FIXTURES (TOLIET, SINK, AND SHOWER STALL), 1/2 BATH = 2 FIXTURES (SINK & TOILET).
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96
HOW MANY BATHROOMS. IF MULTIPLE UNITS HOW MANY PER UNIT
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97
HEATING AND AIR CONDITIONING
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98
WHAT TYPE OF HEATING SYSTEM?
Gas, oil, heat pump etc
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99
ARE THERE FIREPLACES OR WOOD STOVES? IF MULTIPLE UNITS LIST TYPES AND #
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100
HEATING AND AIR CONDITIONING AND FIREPLACE NOTES:
For office use only
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101
DOES THE DWELLING HAVE AIR CONDITIONING?
Yes
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102
SWIMMING POOL, TRAMPOLINE, HOT TUB
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103
DOES THE UNIT HAVE A SWIMMING POOL:
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104
POOL FENCE:
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105
DIVING BOARD OR SLIDE:
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106
SWIMMING POOL NOTES
Office use only
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107
DO THE UNITS HAVE A TRAMPOLINE?
Yes
No
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108
IS THE TRAMPOLINE FENCED?
Yes
No
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109
DO THE UNITS HAVE A HOT TUB?
Yes
No
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110
DOES THE HOT TUB HAVE A LOCKING LID?
Yes
No
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111
LOSSES

BELOW RECORD, ANY LOSSES YOU HAVE HAD IN THE LAST 5 YEARS
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112
HAVE YOU HAD A LOSS IN THE LAST 5 YEARS:
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113
LOSS DATE:
Date
Month
Day
Year
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114
LOSS:
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115
DESCRIPTION:
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116
LOSS AMOUNT:
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117
ADD LOSS
Select to add another loss
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118
LOSS DATE:
Date
Month
Day
Year
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119
LOSS:
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120
DESCRIPTION:
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121
LOSS AMOUNT:
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122
ADD LOSS
Select to add another loss
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123
Date
Month
Day
Year
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124
LOSS:
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125
DESCRIPTION:
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126
LOSS AMOUNT:
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127
ADD LOSS
Select to add another loss
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128
LOSS DATE:
Date
Month
Day
Year
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129
LOSS:
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130
DESCRIPTION:
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131
LOSS AMOUNT:
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132
ADD LOSS
Select to add another loss
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133
LOSS DATE:
Date
Month
Day
Year
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134
LOSS:
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135
DESCRIPTION:
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136
LOSS AMOUNT:
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137
UNDERWRITING, CURRENT INSURER
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138
CURRENT INSURER:
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139
YEARS WITH CURRENT INSURER?
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140
CURRENT INSURER EXPIRATION DATE?
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141
WHO PAYS THE INSURANCE
Self pay
Lender
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142
RENOVATIONS

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143
HAVE THERE BEEN ANY RENOVATIONS TO THE WIRING, PLUMBING, HEATING, OR OTHER
Yes
No
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144
PLEASE DESCRIBE THE RENOVATIONS INCLUDING THE DATE AND TYPE
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145
DOGS AND PETS
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146
DO YOU ALLOW PETS
Yes
No
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147
DESCRIBE THE BREED AND OR TYPE OF PETS ALLOWED
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148
HOW MUCH RENT DO YOU CHARGE MONTHLY?
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149
COVERAGES / LIMITS
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150
DO YOU KNOW YOUR COVERAGE?
Yes
No
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151
LIST CURRENT COVERAGE
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152
DO YOU HAVE HARD WIRED SMOKE DETECTORS?
Yes
No
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153
ADDITIONAL COMMENTS OR QUESTIONS
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154
DO YOU OWN ANY OTHER RENTAL PROPERTIES?
Yes
No
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155
HOW MANY?
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156
WOULD YOU LIKE A QUOTE NOW OR IN THE FUTURE?
Yes
No
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157
WHICH AGENT ASSISTED YOU WITH THIS QUOTE? IF YOU DON'T REMEMBER PLEASE SELECT "INNEROFFICE@PRLINSURANCE.COM"* This field is required
inneroffice@prlinsurance.com
Required field
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158
By submitting this form, you acknowledge PRL Insurance could and may access consumer report information such as claims histories and credit-based insurance scores where permitted by law to determine the premium you pay for insurance coverage.

Your insurance score uses information from your credit report to help predict how often you're likely to file a claim, and how expensive those claims will be. When we access your credit-based insurance score, it has no impact on your credit rating.

Both your Social Security Number and insurance score are kept confidential and secure, and will not be resold or redistributed.

We may also submit your information to an authorized third party to obtain and prefill information about your property for you to confirm when you complete the quote request application.
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Should be Empty:

TELL US ABOUT YOU

MORTGAGE & TITLE INFORMATION

CO-APPLICANT

DWELLING INFORMATION

FIRE PROTECTION

CONSTRUCTION AND HOME FEATURES

BATHROOM AND KITCHEN

FULL BATH = 3+ FIXTURES (TOLIET, SINK AND BATHTUB), 3/4 BATH = 3 FIXTURES (TOLIET, SINK, AND SHOWER STALL), 1/2 BATH = 2 FIXTURES (SINK & TOILET).

UNDERWRITING, CURRENT INSURER

RENOVATIONS