Customer Information

Name

Last Name

Email Address

Phone

Password

Confirm Password

Are you a management company?

Yes

Property Information

Address

City

Number of bedrooms

Desired Policy Start Date

Type of property

Single Family House

Apartment/Condo

Townhouse

Multifamily

Does this property have functioning fire alarms?

Yes

Does this property have a sprinkler system?

Yes

Term Length:

12 months

Proposed Effective Date:

Property Address:

Rate effective until:

Underwritten by:

Lloyd's of London

Discount Type	Proposed
Has Fire Alarm	Applied
Has Sprinker System	Applied

	Proposed
Monthly Renters Premium
Monthly Renters Tax

By clicking the Pay buttons below you are enrolling in a Renters Insurance Program and your credit card will be charged according to the fees shown.

Property	Months	Price
	12	$575.52
Government Fees and Taxes		$
Subtotal	12	$
Program Fee	12	$40
Total		$

Pay ($)