IMPORTANT NOTICE

1. This vacant property insurance quote request applies only to the states of Oregon and Washington. Do not fill out this form if your vacant property is not located in Oregon or Washington.

2. No insurance will be started by submitting this form. Coverage may be placed in force only after you decide to purchase it from us, and then after you complete and sign the insurance application and pay the initial premium.

3. Insurance companies may use information from you and other sources which pertains to your ability to meet financial obligations. By submitting this quote request, you are giving permission for the possible access and review of your credit history and credit rating. This authorization extends to Beaverton-Tigard Insurance and to any insurance company that it may contact for the purpose of obtaining coverage for you and/or your business. This authorization is to remain in force until you choose to rescind it in writing.

4. Submitting the following quote request constitutes your agreement with the above statements. We will contact you within two business days after we receive your request. If you have questions concerning this notice or about the following form, please call us at 503-620-0230 or 1-888-620-0230.

Vacant Property Quote Request
  1. Your First Name
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  2. Last Name
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  3. Phone Number
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  4. Email Address
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  5. Date of Birth
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  6. Social Security Number
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  7. Vacant property street address
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  8. City
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  9. State
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  10. Zip Code
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  11. Describe details of vacant property
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  12. How long has it been vacant?
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  13. Why is the property vacant?
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  14. What is current building replacement cost
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  15. What year was building built?
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  16. What is square footage?
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  17. Construction Type
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  18. Type of Foundation
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  19. Primary Heating Method
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  20. Year Updated Heating
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  21. Type of Roof
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  22. Year Updated Roof
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  23. Year Updated Plumbing
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  24. Year Updated Electrical
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  25. Current building condition
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  26. Describe All Security Devices
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  27. Currently insured?
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  28. If yes, current insurance company
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  29. Date current insurance will expire
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  30. How long is coverage needed?
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  31. Is contents coverage needed?
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  32. If "Yes," how much contents coverage needed?
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  33. Your Street Address
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  34. Your City
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  35. Your State
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  36. Your Zip Code
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  37. Additional Information or Comments
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  38. Re-type the security field numbers in the box.
  39. Security Field
    Security Field The Security code you typed did not match. Please click "Refresh" and try again.
  40. To keep a copy of this form, please Print before Submitting
  41.   

 

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Questions?

If you have questions concerning this information, please call us at 503-620-0230, or come in.

Llámenos ya al 503-620-0230.