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For Renters and Condo Owners
REQUIRED INFORMATION FOR QUOTE

Thank you for selecting Spiridon Insurance Group for a Quick Renters or Condo Owners Insurance Quote. Our goal is to provide our valued clients with a superior insurance policy at the most economical price. Spiridon provides their clients with
"Peace of Mind" because they have the right protection.

If you prefer, please complete the Information Sheet and fax to us.

First Name:		Last Name:*
Date of Birth:		Social Security Number:
Joint Owner First Name:		Joint Owner Last Name:
Date of Birth:		Social Security Number:
Street Address:*		City:
State:		Zip:*

Phone:*		How may we contact you?
Alternate Phone:			Telephone
e-mail:			email

Marital Status:	Married Single
Does anyone else live with you?	Yes No	Is anyone over 55 retired?		Yes No
When did you move in?		If less than 2 years, list previous address
List the approximate value of your contents
If condo, how much interior dwelling coverage would you like?
Smoke Detectors:	Yes No		Deadbolts:	Yes No
Fire Extinguishers:	Yes No		Monitored Alarm System:	Yes No
Gated or Manned Security Service:			Yes No
We can save you additional money by insuring your autos also, would you like a proposal?				Yes No

Special comments or questions:

*denotes required field

CALL TOLL FREE 1-877-774-7436