Renters, Condo, and Co-op Insurance Quote Request Form

The information submitted via this form is confidential.  If you have a policy currently, the information necessary to complete this form can be found on the declaration page.  Fill in this form as completely as possible to ensure an accurate rate. If you DO NOT KNOW the correct answer to any of the fields, other than the required fields, skip them, but note in the comments section what you DO NOT KNOW.

ABOUT YOU
Name
Address
Town
State
Zip

Daytime Phone

Evening Phone
Fax
Email

ABOUT THE PROPERTY
Type of quote
Select the type of building you live in
What is the construction of your building
Do you own the unit you live in?
Number of Rooms
Square Footage

 

CURRENT POLICY DETAILS
Are you currently Insured?
Current Insurance Company
Policy #
Expiration Date
If currently insured, any claims in the last 3 years?
Claim Details

SECURITY FEATURES
Security Features (check all that apply)
 
Smoke Detectors
Fire Extinguishers
Local Fire Alarm
Local Burglar Alarm
Central Station Fire Alarm
Central Station Burglar Alarm
Dead bolts
   

 

POLICY DETAILS
Value of personal property?
Liability Coverage
   
Other types of insurance you currently have  
 
Auto
Business
Life
Comments

 

GCS Mortgage, Inc. 31 East 32nd Street, 4th Floor New York, NY 10016 Tele: 212 545-9201 Fax: 212 447-4890                          E-Mail: info@gcsmortgage.com