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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 Ohio)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail (again for accuracy):
Phone:
Fax (optional):

Dwelling Information

Year Dwelling Built:
Home Square footage:

# Units in common 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?

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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Ohio Car-Insurance.com - A Service of Preston, Planck, and Preston Insurance
Phone: 513-734-6441 / Toll-Free: 800-719-6773 / Fax: 513-734-3341
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2709 Saltair Maple Road Bethel, OH 45106