Skip to main content
#
Lehman Insurance Agency
home
policy service
claims
contact
site map
About Us
Carriers Represented
Home
Get A FREE Quote
Automobile
Boat
Condominium
Flood
Homeowners
Manufactured Homes
Motorcycle
Motorhome
Renters
Umbrella
Personal Insurance
Business Owners Policy
Workers Compensation
Property & Liability
Specialty Liability
Commercial Vehicles
Miscellaneous Commercial Insurance
Business Insurance
Life
-- Term Life Insurance
-- Permanent Life Insurance
Long Term Care
Financial Services
Make A Payment
Claims
Customer Service
Contact Us
 Renters Quote 
Form: Renters Insurance Quote Form
Renters Insurance Quote Form




Contact Information
Full Name:
Day Telephone:
Street Address:
Eve Telephone:
City, State & Zip:
Fax:
E-Mail Address:
Your occupation:
Best Time To Reach You:
Date of Birth:
Social Security #
Current Insurance Information
Insurance Company Name:
(NOT Insurance Agency/Broker)
Policy Exp. Date:
$ Contents Insured for:
Current Ded:
Premium Amt:
Policy Term:
General Information
Will you or do you live on this property:
yes no
How much coverage do you want on your personal property:
$
How much personal liability:
$100,000 $300,000
$500,000 $1,000,000
Deductible:
$500 $750 $1,000
$2,000
Number of Units:
Number of Stories:
Is there a 24-hour door man:
yes no
Are there elevators:
yes no
Year Built:
(yyyy)
Approximate Square Feet:
Have you reported any claims or losses to your insurance company within the last 5 years
yes no
Type of Construction:
brick wood frame
cinder block other
Roof Type:
composite shingle tile
wood shingle other
Roof Age:
years (if unknown, please indicate)
Burglar Alarm:
yes no
Heating System:
forced air electric boiler
oil propane
Number of gas or wood fireplaces or stoves:
What floor do you live on:
Number of bathrooms:
Additional Information
Any business conducted in home: (if yes, please describe)
 yes no
List values of any jewelry, furs, or specialty items:
List pets & breeds:
Additional Comments
Please give any additional comments or questions

No coverage of any kind is bound or implied by submitting information via this online form

  • Information from you and other sources, such as your driving, claims and insurance histories, may be used to calculate an accurate price for your insurance.
  • We will not distribute information to other parties other than for insurance underwriting purposes.
  • By submitting this form, you agree to release us from any liability should this information be accidentally viewed by others.

Manage Your Policy 
Auto ID Cards
Change of Address
Change of Name
Certificate of Insurance

Visit our online customer service center here.
Site Mailing List 

© Lehman Insurance Agency, 2007 Powered By: Insurance Web Designs