DWELLING RENTAL WEB QUOTE

1
TELL US ABOUT YOU
2
WHAT DO THEY CALL YOU* This field is required.
First Name
Middle Initial
Last Name
3
WHERE CAN WE SEND THE MAILJust start typing we'll do the rest try its fun and easy
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
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Aruba
Australia
Austria
Azerbaijan
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Botswana
Brazil
Brunei
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Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
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Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
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Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
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Democratic Republic of the Congo
Denmark
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Dominican Republic
Ecuador
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Falkland Islands
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Fiji
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France
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The Gambia
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North Korea
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Kosovo
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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
United States
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
4
THE DAY YOU WERE BORNTell us the date
MM/DD/YYYY
5
GENDER
Female
Male
Other
6
MARITAL STATUS:
Married
Single
Widowed
Divorced
Separated
7
EMPLOYMENT:
Employed
Homemaker
Student
Military
Disabled
Retired
Unemployed
8
OCCUPATION:
9
E-MAIL:* This field is required.
10
HOME PHONE:
11
CELL PHONE:
12
ADDITIONAL NOTES:
For office use only
13
LEAD SOURCE:
Yelp
Google
Internet
Facebook
Our website
Referral
Other
Where did you hear about us
14
REFERRAL NAME:
Enter the name of the person who told you about PRL
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
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
Curaçao
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
United States
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
16
IS THE PROPERTY CURRENTLY OCCUPIED:
YESNO
17
PURCHASE DATE:
MM/DD/YYYY
18
MORTGAGE & TITLE INFORMATION
19
IS THERE A MORTGAGE ON THE PROPERTY?
Yes
No
20
How many
1
2
3
4
5
21
MORTGAGE NOTES
For office use only
22
NAME(S) ON THE TITLE OF THE HOUSE
23
IS THE HOME IN A TRUST OR LLC
Yes
No
24
TRUST OR LLC INFORMATION
If LLC, how many members in the LLC please list them by name
25
WILL THERE BE A PROPERTY MANAGEMENT COMPANY
Yes
No
26
DOES THE PROPERTY MANAGEMENT COMPANY NEED TO BE NAMED AS ADD'L INSURED?
Yes
No
27
PROPERTY MANAGEMENT COMPANY INFORMATION
Include name address and contact person
28
WILL YOU REQUIRE THE TENANT TO CARRY RENTERS INSURANCE?
Yes
No
29
IS THERE A LEASE AGREEMENT?
Yes
No
30
How many months is the lease agreement
31
ADDITIONAL PROPERTY NOTES
Office use only
32
DO YOU HAVE LIFE INSURANCE TO COVER YOUR MORTGAGE?
Yes
No
33
LIFE INSURANCE NOTES:
Office use only
34
DOES YOUR DESCRIBED ADDRESS INCLUDE MORE THAN 1 TAX LOT?
Yes
No
35
TAX LOT INFORMATION
Please describe additional tax lot situation
36
IS THE PROPERTY LOCATED BY WATERFRONT?
Yes
No
37
WATERFRONT NOTES
Describe the property and location in regards to the waterfront
38
DO YOU WANT FLOOD INSURANCE?
Yes
No
39
DOES YOUR MORTGAGE LENDER REQUIRE IT?
Yes
No
40
IF NEW PURCHASE, DO CURRENT OWNERS HAVE IT?If yes often we can transfer from current owners to new owners.
Yes
No
41
FLOOD INSURANCE NOTES AND COMMENTS
For office use only
42
DO YOU WANT EARTHQUAKE (EQ) INSURANCE?
Yes
No
43
EARTHQUAKE NOTES AND COMMENTS
Office use only
44
DO YOU WANT LANDSLIDE INSURANCE?
Yes
No
45
LANDSLIDE INSURANCE NOTES
Describe the situation slope, water problems etc.
46
PROPERTY NOTES
Office use only
47
IS THERE A CO-APPLICANT?:
No
No
Yes
48
CO-APPLICANT
49
NAME:
First Name
Middle Initial
Last Name
50
BIRTH DATE:
Date
Month
Day
Year
51
GENDER:
Female
Male
52
MARITAL STATUS:
Married
Single
Widowed
Divorced
Separated
53
EMPLOYMENT:
Employed
Homemaker
Student
Military
Disabled
Retired
Unemployed
54
E-MAIL:
55
APPLICANT RELATION:
Spouse
Child
Sibling
Parent
Employee
Other
Roommate
SigOther
Relative
56
DWELLING INFORMATION
57
NUMBER OF FAMILIES:
1
1
2
3
4
58
YEAR BUILT
YYYY
59
YEAR BUILT:
Please Select
Please Select
2025
2024
2023
2022
2021
2020
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
60
CONSTRUCTION:
Masonry
Frame
Log
Superior
61
OCCUPANCY STATUS:
Primary
Secondary
Seasonal
Vacant
62
RESIDENCE TYPE:
Dwelling
RowHouse
63
CIRCUIT PANEL:
Circuits
Fuses
64
COURSE OF CONSTRUCTION:
Yes
65
DWELLING NOTES AND COMMENTS
Office use only
66
FIRE PROTECTION
67
IS THE DWELLING WITHIN THE CITY LIMITS:
Yes
No
68
DISTANCE FROM NEAREST FIRE STATION:
2 miles or less
5 miles or less
10 miles or less
Greater than 10 miles
69
IS THE DWELLING WITHIN 1000 FT. OF A FIRE HYDRANT?
Yes
No
70
CONSTRUCTION AND HOME FEATURES
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)
72
TOTAL LIVING AREA (SQ FT) NOT INCLUDING BASEMENTS OR ATTICS:
73
DOES THE DWELLING HAVE A BASEMENT?
Yes
No
74
HOW MANY SQ FT FINISHED
75
HOW MANY SQ FT UNFINISHED
76
IS THERE A SUMP PUMP
Yes
No
77
BASEMENT NOTES:
Is it finished, unfinished, walkout etc
78
DOES THE DWELLING HAVE AN FINISHED ATTIC?
Yes
No
79
HOW MANY SQ FT?
80
DOES THE DWELLING HAVE A DECK?
Yes
No
81
NUMBER OF DECKS
82
DECK COMPOSITION
Wood
Composite
83
STYLE OF DWELLING:
1 Story
1.5 Story
2 Story
2.5 Story
3 Story
Ranch
Bungalow
Rambler
Queen Anne
Cape-Cod
Colonial
Mediterranean
Federal Colonial
Southwest Adobe
Cottage
Row House End
Row House Center
Town House End
Town House Center
Victorian
Ornate Victorian
Condo/Co-op
84
NUMBER OF STORIES:
1
1.5
2
2.5
3
4
85
DOES THE DWELLING OR DWELLINGS HAVE A GARAGE OR CARPORT
Yes
No
86
PLEASE DESCRIBE
Detached, carport, detached garage etc.
87
GARAGE TYPE:
None
Attached Garage - 1 Car
Attached Garage - 2 Car
Attached Garage - 3 Car
Basement Garage - 1 Car
Basement Garage - 2 Car
Basement Garage - 3 Car
Built-in Garage - 1 Car
Built-in Garage - 2 Car
Built-in Garage - 3 Car
Carport - 1 Car
Carport - 2 Car
Carport - 3 Car
88
HAS THE ROOF BEEN REPLACED?
Yes
No
89
WHEN WAS IT REPLACED?
90
FOUNDATION TYPE:
Slab
Crawl space
Basement
Pier foundation
91
BASEMENT % FINISHED:
92
DAYLIGHT BASEMENT:
Yes
No
93
LAND SLOPE
Flat to slight slope (flat to .15 degrees
Moderate slope (15-30 degrees)
Steep slope (30+ degrees)
94
FOUNDATION AND LAND SLOPE NOTES
Office use only
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).
96
HOW MANY BATHROOMS. IF MULTIPLE UNITS HOW MANY PER UNIT
97
HEATING AND AIR CONDITIONING
98
WHAT TYPE OF HEATING SYSTEM?
Gas, oil, heat pump etc
99
ARE THERE FIREPLACES OR WOOD STOVES? IF MULTIPLE UNITS LIST TYPES AND #
100
HEATING AND AIR CONDITIONING AND FIREPLACE NOTES:
For office use only
101
DOES THE DWELLING HAVE AIR CONDITIONING?
Yes
102
SWIMMING POOL, TRAMPOLINE, HOT TUB
103
DOES THE UNIT HAVE A SWIMMING POOL:
None
Above ground
Below ground
104
POOL FENCE:
Yes
No
105
DIVING BOARD OR SLIDE:
Yes
No
106
SWIMMING POOL NOTES
Office use only
107
DO THE UNITS HAVE A TRAMPOLINE?
Yes
No
108
IS THE TRAMPOLINE FENCED?
Yes
No
109
DO THE UNITS HAVE A HOT TUB?
Yes
No
110
DOES THE HOT TUB HAVE A LOCKING LID?
Yes
No
111
LOSSES

BELOW RECORD, ANY LOSSES YOU HAVE HAD IN THE LAST 5 YEARS
112
HAVE YOU HAD A LOSS IN THE LAST 5 YEARS:
No
Yes
113
LOSS DATE:
Date
Month
Day
Year
114
LOSS:
Contamination / Pollution
Earth Movement
Earthquake
Fire
Flooding
Freezing water / frozen subsequent damage
Hail Damage
Theft
Smoke Damage
Theft
Vandalism - malicious mischief
Water Damage
Wind
115
DESCRIPTION:
116
LOSS AMOUNT:
117
ADD LOSS
Select to add another loss
118
LOSS DATE:
Date
Month
Day
Year
119
LOSS:
Contamination / Pollution
Earth Movement
Earthquake
Fire
Flooding
Freezing water / frozen subsequent damage
Hail Damage
Theft
Smoke Damage
Theft
Vandalism - malicious mischief
Water Damage
Wind
120
DESCRIPTION:
121
LOSS AMOUNT:
122
ADD LOSS
Select to add another loss
123
Date
Month
Day
Year
124
LOSS:
Contamination / Pollution
Earth Movement
Earthquake
Fire
Flooding
Freezing water / frozen subsequent damage
Hail Damage
Theft
Smoke Damage
Theft
Vandalism - malicious mischief
Water Damage
Wind
125
DESCRIPTION:
126
LOSS AMOUNT:
127
ADD LOSS
Select to add another loss
128
LOSS DATE:
Date
Month
Day
Year
129
LOSS:
Contamination / Pollution
Earth Movement
Earthquake
Fire
Flooding
Freezing water / frozen subsequent damage
Hail Damage
Theft
Smoke Damage
Theft
Vandalism - malicious mischief
Water Damage
Wind
130
DESCRIPTION:
131
LOSS AMOUNT:
132
ADD LOSS
Select to add another loss
133
LOSS DATE:
Date
Month
Day
Year
134
LOSS:
Contamination / Pollution
Earth Movement
Earthquake
Fire
Flooding
Freezing water / frozen subsequent damage
Hail Damage
Theft
Smoke Damage
Theft
Vandalism - malicious mischief
Water Damage
Wind
135
DESCRIPTION:
136
LOSS AMOUNT:
137
UNDERWRITING, CURRENT INSURER
138
CURRENT INSURER:
139
YEARS WITH CURRENT INSURER?
140
CURRENT INSURER EXPIRATION DATE?
141
WHO PAYS THE INSURANCE
Self pay
Lender
142
RENOVATIONS
143
HAVE THERE BEEN ANY RENOVATIONS TO THE WIRING, PLUMBING, HEATING, OR OTHER
Yes
No
144
PLEASE DESCRIBE THE RENOVATIONS INCLUDING THE DATE AND TYPE
145
DOGS AND PETS
146
DO YOU ALLOW PETS
Yes
No
147
DESCRIBE THE BREED AND OR TYPE OF PETS ALLOWED
148
HOW MUCH RENT DO YOU CHARGE MONTHLY?
149
COVERAGES / LIMITS
150
DO YOU KNOW YOUR COVERAGE?
Yes
No
151
LIST CURRENT COVERAGE
152
DO YOU HAVE HARD WIRED SMOKE DETECTORS?
Yes
No
153
ADDITIONAL COMMENTS OR QUESTIONS
154
DO YOU OWN ANY OTHER RENTAL PROPERTIES?
Yes
No
155
HOW MANY?
156
WOULD YOU LIKE A QUOTE NOW OR IN THE FUTURE?
Yes
No
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
inneroffice@prlinsurance.com
alena@prlinsurance.com
angeline@prlinsurance.com
Jennifer@prlinsurance.com
kristine@prlinsurance.com
lori@prlinsurance.com
theresa@prlinsurance.com
sierra@prlinsurance.com
Required field
158
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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.
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