9 Fortunes Insurance Services

🆔 Agent: *

🌐 Lang:

💬 WeChat (Opt):

Property / Homeowners Quote

Complete coverage for property and personal assets.

I. Property Address & Use

Property Address (Complete) *

Occupancy / Usage *

Primary Rental

II. Property Owners (Owner 1 Required, 2/3 Optional)

👤 产权人 1 (Owner 1) * ▼

Name *

Gender *

DOB *

Phone *

Email *

👤 产权人 2 (Owner 2 - 可选) ▼

Name

Gender

DOB

Phone

👤 产权人 3 (Owner 3 - 可选) ▼

Name

Gender

DOB

Phone

III. Additional Specs (Optional)

Year Built

Sq Footage

Structure Type

Security System

Yes No

Notes

Auto Insurance Quote

Vehicle details fully required. Primary driver and prior policy details required.

I. Vehicle Specifications (All Required)

VIN (Vehicle ID Number) *

Make *

Model *

Year *

Plate # *

Primary Usage *

Garaging Address *

II. Driver Information (Driver 1 Required, 2~5 Optional)

🚗 主要驾驶人 (Driver 1 - Primary) * ▼

Name *

DL# *

DOB *

Phone *

Email *

🚗 驾驶人 2 (Driver 2 - 可选) ▼

Name

DL#

DOB

Phone

🚗 驾驶人 3 (Driver 3 - 可选) ▼

Name

DL#

DOB

Phone

🚗 驾驶人 4 (Driver 4 - 可选) ▼

Name

DL#

DOB

Phone

🚗 驾驶人 5 (Driver 5 - 可选) ▼

Name

DL#

DOB

Phone

III. Prior Insurance Policy (All Required Except Accidents)

Carrier Name *

Policy # *

Effective Date *

Expiration Date *

Coverage Level *

Annual Premium ($) *

Vehicle Financed/Leased *

Yes No

Recent Accidents/Violations (Optional)

Renters Insurance Quote

Rental property address fully required. Primary tenant required.

I. Rental Premises Address (All Required)

Rental Street Address *

City *

State *

Zip *

Building Type *

Lease Start *

Lease End *

II. Tenant Information (Tenant 1 Required, 2~5 Optional)

🛋️ 主要住客 (Tenant 1 - Primary) * ▼

Name *

DOB *

Phone *

Email *

🛋️ 住客 2 (Tenant 2 - 可选) ▼

Name

DOB

Phone

🛋️ 住客 3 (Tenant 3 - 可选) ▼

Name

DOB

Phone

🛋️ 住客 4 (Tenant 4 - 可选) ▼

Name

DOB

Phone

🛋️ 住客 5 (Tenant 5 - 可选) ▼

Name

DOB

Phone

III. Additional Specs (All Optional)

Sq Footage

Monthly Rent ($)

Landlord / Mgmt Co

Phone

Pets (Breed/Qty)

Smokers?

Notes

Health Insurance Quote

8 household members (Self required, rest optional) with plan preferences.

I. Primary Applicant & Address

Home Street Address *

Estimated Household Tax Income *

Primary Applicant Name *

SSN / ID *

Phone *

Email *

City *

State *

Zip *

Total Members *

II. Family Members (Self Required, 2~8 Optional)

🏥 成员 1 (Member 1 - Self / 本人) * ▼

Name *

Relation *

DOB *

Age *

Gender *

Tobacco *

🏥 成员 2 (Member 2 - 可选)▼

Name

Relation

DOB

Age

Gender

Tobacco

🏥 成员 3 (Member 3 - 可选)▼

Name

Relation

DOB

Age

Gender

Tobacco

🏥 成员 4 (Member 4 - 可选)▼

Name

Relation

DOB

Age

Gender

Tobacco

🏥 成员 5 (Member 5 - 可选)▼

Name

Relation

DOB

Age

Gender

Tobacco

🏥 成员 6 (Member 6 - 可选)▼

Name

Relation

DOB

Age

Gender

Tobacco

🏥 成员 7 (Member 7 - 可选)▼

Name

Relation

DOB

Age

Gender

Tobacco

🏥 成员 8 (Member 8 - 可选)▼

Name

Relation

DOB

Age

Gender

Tobacco

III. Plan Preferences & Budget

Target Effective Date *

Monthly Budget ($) *

Plan Network *

Doctor Preference? *

Dental / Vision? *

Chronic Conditions? *

Long-term Meds? *

Metal Tier *

Bronze Silver Gold Platinum

IV. Additional Info (All Optional)

Current Carrier (Optional)

Employer Plan (Optional)

Notes

Commercial Insurance Quote

Professional Protection, Peace of Mind · Section VI Claim description optional.

I. Business Info

Business Name *

Insured Full Name *

Entity Type *

FEIN / Tax ID *

Year Est *

Website *

Business Address *

Phone & Email *

II. Property Details

Risk Address *

Owned / Leased *

Owned Leased

Square Footage *

Year Built *

Security Alarm *

Sprinklers *

III. Coverage & Policy Details

Locations # *

Contents Val ($) *

Improvements Val ($) *

Annual Revenue ($) *

Liability Limit ($) *

Hours *

IV. Business Operations

Operations Description *

Role *

Origin *

Company Vehicles *

V. Employee Information

Full-Time Staff *

Part-Time Staff *

Job Duties *

Total Payroll ($) *

VI. Claims History (Description Optional)

Carrier Name *

4-Year Loss Runs *

Claim Description (Optional)

Property / Homeowners Quote

Auto Insurance Quote

Renters Insurance Quote

Health Insurance Quote

Commercial Insurance Quote

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