The Pratt Insurance Agency, Inc.

Request a Renter's Quote

Please fill out the form below giving us as much information as possible, to ensure the most accurate quote.
Once we receive your information, we will contact you as soon as possible - usually within one business day.

Gender *

Male

Female

Name Prefix

First Name *

Last Name *

Email Type

Email *

Date of Birth *

Social Security Number

Phone Type

Phone Country

Phone Number *

Phone Extension

Address Type

Address Country

Address 1 *

Address 2

Address City *

Address State

Address Zip Code *

Marital Status *

Married

Single

Do you currently have a renter's Policy? *

Yes

If Yes, who is your present carrier?

If yes, is it under cancellation?

Yes

Do you have any prior losses?

Yes

If yes, please explain further:

Have you had a bankruptcy or Foreclosure in the last 5 years? *

Yes

Property Information

Construction *

Frame

Masonry

Mobile Home

Other

Approximate Distance to nearest Fire Station *

Approximate Distance to nearest Fire Hydrant *

Year Built *

# of Families *

Smoke Detectors *

Yes

Deadbolts *

Yes

Fire Extinguishers *

Yes

Does anyone in household smoke? *

Yes

Woodstove(s) or Fireplace(s)? *

Yes

Inground Swimming Pool *

Yes

Above Ground Swimming Pool *

Yes

If there is a pool, is it Fenced with a Secure Gate *

Yes

Trampoline *

Yes

Do you own any dogs? *

Yes

If Yes, what is the Age, Breed and Temperament?

Is any Business conducted at home? *

Yes

If Yes, please explain:

Amount of Insurance Coverage Needed for Contents *