Earthquake EZ-App

For Faster service on your commercial earthquake accounts complete the form below and hit the "Continue" button. Your submission will be electronically delivered to the next available underwriter.

Applicant Information

Applicant Name Applicant Website Address Location Address Mailing Address: (If different from location address) Description of Risk Expiring Carrier

Willing to Renew? N/A Yes No

Target Premium Deductible

Property Information

Building Amount: Contents Amount: If Apt, Number of Units: Building Shape: (Regular or Irregular) Living Space Square Footage: Loss of Income: Number of Stories: Tenancy?: Primary Occupancy: Construction Type: Parking Type Parking Square Footage:

Agency Information:

Agency Name: Contact Person: Phone Number: Fax Number: E-Mail Address:

Earthquake EZ-App

Applicant Information

Property Information

Building Information:

Agency Information: