Short-Term Rental Application Named Insured*Email* Phone Number*Are you an Insurance Agent?*YesNoAgency NameAgent NameAgent Phone NumberAgent Email Do you use a professional property manager?*YesNoName of Property Management CompanyDo you plan to use a professional property manager?*YesNoWould you like a referral to a property manager?*YesNoDo you advertise your vacation rental online?*YesNoPlease provide or paste URL/Web AddressNot required for quote, but if available, please provide URL/web address below.How did you find Grit?Internet Search - GoogleInternet Search - Bing/YahooBlog/Discussion ForumReferral - HomeAway/VRBOReferral - Current Proper CustomerReferral - Your Property ManagerReferral - Your Real Estate AgentReferral - AirbnbPost Card MailerFacebookIndustry Trade ShowOtherDate*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Rental Property Street Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country If applicable, what is the name, or DBA, of your vacation rentalIs this property a new purchase?*YesNoPart of a Condominium Association?*YesNoIs this rental also your primary residence?*YesNoList all adult resident(s)Do you own a dock or pier at this location?*YesNoDoes this rental offer a bunk bed or loft accessed by a ladder?*YesNoDoes this rental offer special events/parties (ex: weddings, reunions, seminars, etc)?*YesNoNumber of Events DaysDoes this rental have an active noise monitoring system?*YesNoDoes this rental have an active automatic water shut-off valve?*YesNoHas there been a covered property claim at this location in the last three years?*YesNoBuilding NoBuilding Type*Single FamilyDuplexTownhomeMult-plexFlat - Condo or ApartmentGarageStorageBoat House or DockOtherBuilding Description (House, Garage, Cottage 1, Lakeside Cabin, etc.)*Construction Type*FrameAll BrickReinforced ConcreteNumber of Bedrooms advertised for Guests*0123456789101112131415161718192021222324252627282930Do you have a central station fire alarm system?*YesNoDoes this building have sprinklers?*YesNoNumber of Stories1234N/AEstimated Square FootageRoof MaterialAsphalt ShinglesShake – Wood or CompositeSlate – Stone or CompositeMetalClay or TileFlat – Tar or MembraneOtherN/A - CondoYear BuiltHas this building been updated?YesNoYear of oldest plumbing fixturesYear of oldest wiringYear of oldest roof materialYear of oldest heating fixtureBuilding Rebuild Value ($)*Contents Value ($)*Loss of Income Value ($)*CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
