CONTACTSMAPHOMEAPPLICATIONS Renter/Owner ProgramROOFER PROGRAMMULTI UNIT BLDGSWORKERS COMPRESTAURANTSFAVORITE SITESBARBER/BEAUTY SHOPSAUTO/TRUCK QUOTEPERSONAL INSURANCE QUOTE REQUEST CONTRACTOR QUOTENOW HIRINGCERTIFICATE REQUESTBONDS GOT LIFE?

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

           R.R.I.S. Fire Dwelling/Rental 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
Personal Information
Gender Age
Marital Status
 
Occupation
     Spouse Occupation  

 
Rental Property Address
Street City
State Zip Code

 
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 Limit Deductible
Dwelling Limit    
 
Discounts
Smoke Detector? Fire Sprinklered?
Auto Carrier? Burglar Alarm?
Alarm Type? 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 04:29 PM