Property Change Request

PERSONAL INFORMATION
Date:
Insured Business/Name:
Insured Business/Email:
Effective Date:
ADD
Is this a new location?	Yes       No
Location Address:
Location City:
Location State:
Location Zip:
Construction Type:	Frame Masonry Non-combustible Masonry non-combustible Fire resistant
Year Built:
Number of Stories:
Total Area:	sq. ft.
Tenant or Owner Occupied:	Tenant Owner Occupied
Building Use:
Building Replacement Value:
Updates:	Furnace
	Plumbing
	Electrical
	Roof
Year(s) Updated:
Contents Replacement Value:
Mortgagee, Additional Interest and/or Loss Payee Name and Address (If any)
Name:
Address:
City:
State:
Zip:
DELETE
Location Address:
Location City:
Location State:
Location Zip:
CHANGE
Please Explain: