Auto Insurance Center Oklahoma City

Renters Quotes

Name
Address
City
State	Oklahoma Only
ZIP Code
E-mail Address
Phone #
Best Time to Call
Send Quote Via	E-mail Phone
Residents Type
Current Renters Insurance	Yes No
If Yes, Current Carrier
Date of Expiration
Social Security Number of all owners

How did you hear about us

Home Information
How Long At Present Address	Year Home Was Built

Sq. Footage (excluding garage & basement)	# of Claims In Last 3 Years:
sq. ft.
Number of Families Living At Residence

Please List any claims within the past three years
None

Structure Information
Type	Construction		Foundation

Roof Type		Roof Age
		Years
Garage Size		Garage Type

Dwelling Information
Deck/Porch/Patio		Fireplaces
Deck Sq. Ft.		# of Chimneys
Porch Sq. Ft.		# of Hearths
Screened Patio Sq. Ft		Wood Burning Stove
Bed Rooms	Bathrooms	Basements
	# of Full # of Half	Sq. Ft.

Additional Features
Heating System		Central Air
		Yes
Security Alarm	Fire Alarm		Smoke Detector
			Yes

Underwriting Questions
Swimming pool	Is pool enclosed		Trampoline

Inside city limits	How many acres		Miles to fire dept.

Any Animals		If yes what kind (breed of dogs)

Please list any updates on Wiring (circuit breakers), Plumbing, and list type of heating system if NOT Central Heat/Air

Amount of coverage on Dwelling		Deductible

Personal Property Information
How much personal property coverage is required	Burglary Coverage Included
	Yes No

List additional information which may help us provide you an accurate quote.
Also list any additional items you would like scheduled with $value.

Information submitted will be held confidential and will be used for quote purposes only.
By pressing Submit you are authorizing us to verify any information including credit scoring, if applicable, to provide you with the best rates and most accurate quote.
No Coverage will be bound by this form.

I authorize AIC to use my information in my file to remarket or check other insurance companies they represent, for the overages or polices on my behalf until I revoke this authority, this includes social security numbers, state drivers license numbers, address and phone numbers. Information will be used for insurance purposes only.

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