Connecticut Renters Insurance Policy Quote

**Information received from this Connecticut Apartment Renters Insurance quote
request form sent to the William Malloy Insurance Agency will be for our use only
and will not be sold, given to or distributed to any other parties. A quote will be
based on the renters insurance policy information provided and does not guarantee
acceptance of the risk by us. The precise coverage afforded is subject to meeting
underwriting guidelines, and the terms, conditions and exclusions of the policy as
issued. By submitting this request you acknowledge that this is neither an offer to
insure nor a guarantee of insurance. Completion of this form does not entitle you to
a Connecticut Renters Insurance policy. We are licensed in Connecticut and will
not provide quotes for other states.

We are your local Fairfield County insurance agency, offering affordable
apartment renters insurance policy services in the following Connecticut cities
and counties: Stamford, Norwalk, Greenwich, Darien, Riverside, Belltown,
Springdale, Round Hill, Old Greenwich, East Norwalk, New Canaan, Glenville,
Byram, Cos Cob, Mianus, North Stamford, Glenbrook, Wilton, Weston, Long
Ridge, Noroton, West Norwalk, Westport, High Ridge, Southport, North Wilton,
Winnipauk, Cannondale, Turn of River, South Wilton, Lyons Plains, Georgetown,
Ridgefield, Branchville, Redding, Topstone, Ridgebury, Redding Ridge,
Branchville, Dodgingtown, West Redding, Titicus, Hattertown, Bethel, Danbury,
New Fairfield, Newtown, Hawleyville, Botsford, Monroe, Bridgeport, Stepney,
Shelton, Huntington, Upper Stepney, Long Hill, Trumbull, Stratford, Easton,
Fairfield, Greenfield Hill, Stratfield, Nichols, Oronoque, Rivercliff, Devon, Lordship,
and East Bridgeport, New Haven, Hartford, Torrington, Waterbury, Meriden, New
Britain, New London, Norwich, Manchester, East Hartford, Suffield, Granby,
West Haven, West Hartford, Branford, East Haven, Hamden, Woodbridge,
Orange, North Haven, Groton, Rocky Hill, Newington, Wethersfield, Glastonbury,
Bloomfield, Blue Hills, South Windsor, Naugatuck, New Hartford, Chesire, East
Lyme, Old Mystic, Wallingford, Southington, Middletown, Bristol, Laurel Beach,
Litchfield, Pleasure Beach, Mystic, North Westchester, Double Beach,
Willimantic, Storrs, Canaan, East Windsor, Vernon, South Canaan, Putnam,
Guilford, Windham, South Britain, Willington, Windsor, East Hampton, Brooklyn,
Westchester, and everywhere else in New Haven County, Litchfield County,
Middlesex County, New London County, Hartford County, Tolland County and
Windham County, CT.

In addition to Connecticut
Renters Insurance, we also
offer affordable Car Insurance
policy premiums or choose
another CT family insurance
coverage from the list below.

Full Name:
Address to be Insured:
City:     State:     Zip Code:
Email Address: (Required)
Home Phone: Work Phone: Ext.
How to Contact You:
Date of Birth:             (mm/dd/yyyy)
Social Security Number:

Do you currently have renters insurance?
Current Premium:$ per month
Coverage requested for?
Usage Type:
Years Lived at Address to be Insured:

Personal Property ($ value):
Personal Liability (each occurence):
Medical Payments (each person):
Deductible:

Actual Cash Value, Contents: Yes No
Replacement Cost, Contents: Yes No

Building Structure:
Year Dwelling Built:     Dwelling Square Feet:
Garage:         Dwelling Location:

Did you have any losses, whether or not paid by insurance, during the
last 3 years, at this dwelling location or any other location?
If the answer to the previous question was "Yes", please explain below.

Date                            Type                            Description of Loss                          Amount of Loss



Additional Information or Comments

Click on the "Submit Quote Information" button below to
send your Connecticut Renters Insurance quote request.**

Applicant Information

Policy Endorsements

Connecticut Renters Insurance - Dwelling Information

Loss History