Add / Delete A Location
Insured's Name:
Contact Name & Number for additional information:
Use the following form to
Add a Location
Street:
City:
State:
Zip:
Effective Date of Change:
Value of Building:
Value of Contents:
Value of Other Limits:
Occupancy:
Construction:
Age of Building:
Square Footage:
Building Updates if over 20 years:
Mortgage Company:
Landlord:
Number of stories:
Sprinklered:
Yes
No
Alarms:
Central Station
Burglar
Fire
if other - describe:
Use the form below to
Delete a Location
.
Street:
City:
State:
Zip Code:
Reason why location is to be deleted:
Sold
Moved
Out of bussines
if other - describe
