Erie Insurance Renters Insurance Application Questions

ALLCHOICE Agent Information

Select Your Advisor*

INSURED INFORMATION

Name*

First Last

Address*

Street Address City State ZIP Code

Mobile Phone

Email

RENTERS INSURANCE QUESTIONS

Does The Applicant currently have Homeowners Insurance With Erie?*

No
Yes

Does The Applicant desire Water Backup or Sup Overflow Coverage?*

No
Yes

Is the dwelling at the indicated property currently owned and occupied as your primary residence?*

Yes
No

Explain

Have you ever had similar insurance on this property or any other property during the past 5 years?*

Yes
No

Which Company(ies)

EXCEPT for non-payment of premium, has any company declined, cancelled, or refused to renew similar insurance?*

Yes
No

Explain

Have you had any losses or claims of any nature, whether insured or not, such as fire, windstorm, theft, liability, etc. on this or any other property during the last 5 years?*

Yes
No

Explain (Year, Approx Cost, Cause)

Are there animals, including farm animals or pets on the premises?*

Yes
No

Provide Animal Type(s) (If Dog include breed) (are any animals dangerous or show propensity to bite)

Is the applicant conducting any business or occupational pursuits at the premises?*

Yes
No

Explain

ALLCHOICE Agent Information

INSURED INFORMATION

RENTERS INSURANCE QUESTIONS

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