New Building Valuation Referral Form

Please fill out the form below in order to submit a new building valuation referral.

*All fields marked in red are required.

Property Information

Property Name:
Property Address:
Property City, State, Zip:
On-Site Contact Name:
On-Site Contact Number:
Transmit Proposal to (if other):
Total Number of Buildings on Site:
Total Number of Original Buildings:
Total Number of Duplicate Buildings:
Total Number of Stories:
Total Number of SF Units:
Total Number of Additional Building Items:
Type of Additional Building Items:

Type of Property

Apartment Complex
Condominium High Rise (over 3 stories)
Condominium Multiple Buildings
Office Building
Warehouse
School
Municipality
Mercantile
Other:

Insurance Information

Insurance Carrier:
Insurance Agent:
Agent Company:
Agent Address:
Agent City, State, Zip:
Agent Phone:
Agent Email:
Current Insured Value:

Client Information

Client Company:
Contact Name:
Contact Title
Contact Phone Number:
Contact Fax Number:
Contact Email Address:
Client Street Address:
Client City, State, Zip:
Other Client Requests:


	Wednesday, September 08, 2010