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For a list of quote forms available, please press "Applications" tab above.

           R.R.I.S. Renter's Questionnaire                 


To request a no-cost, no-obligation insurance quote, just fill out the information below and press the submit button.

You may print and fax to our office if you wish.  We'll have a representative call at your convenience to give you a quote.

Ritchie and Rose Insurance Services, Inc. DOI#0F44143

PO Box 1114, Anderson, CA  96007

email: sherir@ritchieandrose.com

http://www.ritchieandrose.com

                                            Phone: 530-365-4705   Toll Free Fax: 866-885-1428                                       

ATTN:  Ritchie & Rose

 (sherir@ritchieandrose.com)
TOLL FREE FAX:  (866) 885-1428
 

Please provide the following information:    

Referral Agent

(The Referral Agent is the name of your Insurance Agent in our office or how you became aware of our website)

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State
Zip/Postal Code
Social Security #
Work Phone
Home Phone
FAX
E-mail
URL
 
Property Address
Street City
State Zip Code


 
About your home
no. of units living sq. footage
year built number of levels
no. of car garage Garage Type
       
no. of bathrooms no. of fireplaces
swimming pools spa
porch deck
heating a/c
       
roof type roof age
construction type    
foundation exterior type


 
Coverage Limits
liability requested Deductible
dwelling    
personal property Loss of Use


 
Discounts
smoke detector sprinkler
auto insurance company burglar alarm
type of alarm non-smoker


 
Insurance information
prior/current carrier
  no. of claims (in last 3 years)

 
1. type of claim
  amount of claim
2. type of claim
  amount of claim
3. type of claim
  amount of claim

 
Comments

Sheri Ritchie / Ritchie & Rose Insurance Services, Inc.
Bus  (530) 365-4705   Fax (866) 885-1428   DOI License No.  
0F44143


sheriritchie@gmail.com
Copyright © 2007 Ritchie & Rose Insurance Services, Inc. All rights reserved.
Revised: 06/08/2013 04:17 PM