Risk Protection of Virginia, Inc.

Renters Insurance Quote Form

Please fill out the form below and we will be sure to get in touch with you soon.

Name
E-mail Address
Daytime Phone	() -
Address Line 1
City
State
Zip Code
Year Built
Brick/Frame
Square Feet
Basement: Yes/No, Square Feet, Finished/UnFinished
No. Bath
No. Bedrooms
No. Stories
Garage: Yes/No
Other Structures (please specify)
Fireplace: Yes/No
Woodstove: Yes/No
Deck: Yes/No, Square Feet
Portch: Yes/No, Square Feet
Subdivisions: Yes/No
Miles from Fire Department
Well or City Water
Moble Home, Townhouse, Doublewide, or Modular (please specify)
Acres of Land
Feet from Fire Hydrant
Smoker: Yes/No
Dead Bolt Locks on Exterior Doors: Yes/No
Smoke Detectors: Yes/No
Fire Extinguisher: Yes/No
Central/Local Alarm, Name of Alarm
Homeowner Association Name
Retired: Yes/No
Toatl Amount $ of Personal Property
Claims in the last 5 years: Yes/No, Year, Cost
Bankruptcy in last 7 years: Yes/No, Year, Chapter filed
Animals (please list type and breed for dogs)
Comments

3054-B Berkmar Drive
Charlottesville, VA 22901
Phone Number: (434) 973-8991
Toll Free: 1 800-435-2806
Fax Number: (434) 973-7778

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