Return to Home Page Great Premium.com Home Page    | An Online Service of the April Insurance Agency
Free Online Insurance Quotes from Great Premium.com
Personal Auto Commercial Auto Contractor Liability Homeowners Motorcycle Comm'l Property Businessowners Workers Comp
FAST Online Insurance Quotes
Let us save you money on your California insurance TODAY! Click on the appropriate coverage below & request a free quote:  
click here for Service Request Form FREE Insurance Tips Newsletter!

click here for Service Request Form Service Request Form

Click Here to Email us Contact Us by Email

Click Here for Our Office Map and Directions Map and Office Directions

Click here to learn more about our agency and services About Our Agency

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 California)
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
Regular Mail
Call me by Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a Quote NOW!


Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!

 
Thanks for visiting the web site of Great Premium.com - a Service of April Insurance Agency (CA Lic#0659943)
E-Mail: info@thinkapril.com   |   More About our Agency's Services
1788 19th Avenue   San Francisco, CA 94122 (Click for Map/Directions)
Phone: 415-242-8100    |    Fax: 415-759-2200   |   Privacy Notice/Copyright Info.
Questions/site-related problems, E-mail us at: info@thinkapril.com    |    2009 Insurance-Web-Sales