Potter & Phillips, Inc.

Quality Service. Affordable Prices.

Welcome to Potter & Phillips Insurance. Give us a call for a quote.

Renters Quote

PLEASE FILL OUT THE FORM BELOW AND SUBMIT FOR A FREE NO-OBLIGATION QUOTE FOR YOUR RENTERS INSURANCE NEEDS:

NORTH CAROLINA RESIDENTS ONLY.

* = Mandatory

Name: *

Leave Blank:

Address 1: *

Address 2:

City: *

State: *

Zip Code: *

Organization:

Home Phone: *

Work Phone:

Fax:

Email: *

Home Information

Policy Type: *

Year Built: *

Type of Unit (Home, apt, condo, townhouse, mobile home, etc): *

Construction Type: *

Plumbing (ex. copper, plastic):

Plumbing Last Updated:

Roof Type (ex. tin, asphalt, shingles):

Roof Last Replaced:

Any Dogs: Yes
No

If Yes, Type & Number of Each Breed:

Garage (ex. attached, detached):

Number of 1
Cars: 2
3
4 or more

Electrical System (ex. breakers, fuses):

Electrical System Last Updated:

Heating Type (ex. gas, oil, etc.):

Heating Last Updated:

Number of Stories: *

Square Feet:

Number of Fireplaces: *

Number of Bathrooms: *

Number of Acres:

Swimming Yes
Pool: * No

If Yes, Is Yes
It Fenced: No

Bankruptcy Yes
Filed: * No

Size Of Decks, Porches & Patios:

Prior Losses In The Last 5 Years:

Alarm Yes
System: * No

Type Of Alarm System:

Responding Fire Department:

Distance From Fire Department:

Personal Items Yes
Insurance (Items that may need to be covered under seperate rider or endorsement): No

If Yes, Give Details And Amounts:

Earthquake Yes
Insurance: No

Flood Yes
Insurance: No

Is There Any Yes
Business Conducted On The Premesis: No

Limits of Coverage

Personal Property:

Loss Of Use:

Personal Liability:

Medical Payments:

Deductible $250
Amount: $500
$1000
$2500

Other Information:

How would you like to receive your quote: