Erie Insurance Renters Insurance Application Questions ALLCHOICE Agent InformationSelect Your Advisor*AJ BrowerJared BellmundHeather BaileyJack WingateMike ReeseBill HeasleyJeff HallEd JohnsonINSURED INFORMATIONName* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mobile PhoneEmail RENTERS INSURANCE QUESTIONSDoes 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 ExplainHave 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 ExplainHave 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 Δ
