California Renters Insurance

Personalized Insurance for the California Renter

Priority Renter Application

After choosing:
   1.  The amount of personal property coverage you want
   2.  The deductible you want

Complete the information requested below click "Submit" and we will:
   1.  Issue the policy
   2.  Contact you to verify coverages and for the 1st payment
        (For security reasons no payment taken with the application)
   3.  Fax a proof of insurance to your leasing agent
   4.  Mail you the documents for signature

                                          

Contact Information

Please complete the form below and submit it to us.

Please provide as much information as possible.  This will save you time when we call you for verification.

*This information is required.

Our phone number is 888-881-0010 and fax number is 866-382-1521

Every policy includes $100,000 in liability coverage.

*Name of Your Apartment Complex:
*Name of Your Leasing Consultant:
*Move in date:
*Amount of Personal Property Coverage:
*Deductible requested:
Adult # 1:
*First Name:
*Last Name:
*Gender:
*Date of Birth:
*Occupation:
Cell Phone #:
*Daytime Phone #:
Evening Phone #:
Email address:
* Street Address of your apartment 1:
Address Street 2:
                
* Street address of previous residence:
*City:
*State:
*Zip Code:
Adult #2:
First Name:
Last Name:
Gender:
Relationship to Adult #1:
Date of Birth:
Occupation:
Cell Phone #:
Daytime Phone #:
Evening Phone #:
Email address:
Comments: