Renter/Condo Application

General Information
Applicant's Name:*
Street Address:*
City/State/Zip:* City:   State:   ZIP:
County:
Current Address (if not same as above):
City/State/Zip: City:   State:   ZIP:
County:
Phone Number:
E-Mail Address:
Who recommended you?:

Apartment/Condo Information
Personal property amount:
When did you move in:
# of Apt./Condo units in building:
Year built:
Central burglar alarm: Yes    No
Central fire alarm: Yes    No
Sprinklers: Yes    No
Smoke detectors: Yes    No
Exterior wall type:
Gated area: Yes    No
Security guard: Yes    No

Loss History in the past 3 years

Month/Year Type of Loss Explanation Paid
1
2

Applicant Information

Applicant Name Date of Birth Occupation Employer (years)
1
2

Prior Insurance Information

Name of carrier:
Policy:
Expiration Date:
How long with current carrier?
 

Office

3720 Chamblee Dunwoody Road, Chamblee, GA 30341 

 

Call us

Tel: (770) 457-8118

Fax: (770) 455-3228

 

Email

informationrequest@iig-insurance.com