Renters Insurance Quote from Gross Insurance Agency, Inc.

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Gross Insurance Agency, Inc.
26 North Ft. Thomas Avenue
PO Box 75249
Ft. Thomas, KY 41075-0249
Phone: 1-859-781-0434
Fax: 1-859-781-1780
E-Mail us at: Gross_Ins@yahoo.com

On-Line Renters Insurance Quote Form One Simple Form - takes only 2-3 Minutes! Your Personal Data:

Your Name:
Property Address:
City:
State:	MUST be Kentucky!
Zip/Postal:
E-Mail (REQUIRED):
E-Mail (again for accuracy):
Phone:
Fax (optional):

Dwelling & Underwriting Information

Year Dwelling Built:

# Units in bldg.:

Type Roof:	Shingle Wood Shake Tar/Gravel Spanish Tile

Number of stories:	One Two Three 4+

Do you own animals or pets?	Yes No
If yes, list type/for dogs, list breed:

Are You Near Brush Area?	Yes No

# of feet to nearest fire hydrant:	# of miles to nearest fire station:

Currently Insured?	Yes No
Name of Carrier & how long insured?

How is Your Credit History?	(Some Carriers use credit to qualify)

Prior Claims?	Yes No
Describe claims in detail:

Plumbing type:	Copper Galvanized Mixed (Copper/Galvanized)

Circuit Breakers or fuses?	Breakers Fuses

# Fireplaces: # Chimneys:

Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)

Coverages:

Contents $ Loss of Use $

Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)

Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):

Send my quotation via: E-Mail Fax
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We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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