Updates to 4 Major Dwelling Systems

Updates of your home's 4 major systems
* Required
Full Name: *
(As it appears on your policy)
Your answer
Phone Number: *
Your answer
Email Address: *
Your answer
Street Address *
Your answer
Roof was updated in what year?
(Approximate year is OK)
Your answer
Electric was updated in what year?
(Approximate year is OK)
Your answer
Plumbing was updated in what year?
(Approximate year is OK)
Your answer
Furnace was updated in what year?
(Approximate year is OK)
Your answer
Submitting this information IS NOT a Policy or Binder of Insurance. No coverage will be bound until you receive confirmation from us.
BY CLICKING THE "SUBMIT" BUTTON BELOW, I CERTIFY THAT THERE IS NO PRE-EXISTING CLAIM, LOSS OR CIRCUMSTANCE LIKELY TO LEAD TO SUCH A CLAIM OR LOSS FOR WHICH I AM APPLYING FOR COVERAGE.
WARNING: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FILES AN APPLICATION FOR INSURANCE CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE PERSON TO CRIMINAL AND [NY: SUBSTANTIAL] CIVIL PENALTIES. IN TN, VA AND WA, INSURANCE BENEFITS MAY ALSO BE DENIED.
NOTICE TO OHIO APPLICANTS: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING HE/SHE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.

Questions? Contact:
Cameron A. Shandersky, CPCU
Schiff Insurance
P.O. Box 145496
Cincinnati, OH 45250-5496
P: 513.870.2580
cameron_shandersky@schiffinsurance.com
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About Author

Cameron A. Shandersky, CPCU
Cameron's Bio