John Fleming Insurance Agency
Tenants
Instructions:  Please fill out the information below. Areas with an asterisk (*) need to be filled in.
Contact Information
Name*
Address
City
Postal Code
Email Address*
Telephone:*
Fax:
   
Detailed Quote Information
1. Value of Your Personal Contents (minimum $30,000.00 Coverage)
2. Deductible Required
3. Limit of Liability Coverage Required
4. Construction of Building
5. Year Building Constructed
6. Number of Units in Building
7. Type of Heating
8. Additional Coverage Required
If Yes, please provide details:
9. Have you had any losses in the last 3 years?
If Yes, please give details and claims amount paid by the insurance company:
Comments