INTERNAL - REI Discovery Form "*" indicates required fields Is this for a current insured or a prospect?* Current Insured Prospect Effective Date for new insurance? MM slash DD slash YYYY Is the First Named Insured a person or an entity?*PersonAn EntityInvestor Name First Last Entity or LLC Name Investor PhoneInvestor Email Investor Date Of Birth MM slash DD slash YYYY Investor Mailing Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Is the Contact Name different from the Investor Name?* Investor and Contact are the same Investor and Contact are different Contact Name First Last Additional PhoneAdditional Email Is the subject property ground up construction or existing?*Existing PropertyGround Up ConstructionProvide full name and mailing address of contractor for ground up constructionIf insured is serving as their own GC, just put "insured"Property Address to be quoted Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Property Type*1-4 Unit Residential5+ Unit ResidentialCommercialOther Asset ClassProperty Use Type*Long Term RentalShort Term Rental (AirBNB/VRBO)Flip/RehabVacantAnnual Lost Rents Coverage Number of Units Policy Term Needed6 Months12 MonthsCoverage Amount ($): How will this policy be paid for?Title company or escrow accountPaid directly by insuredList any applicable mortgagee or lienholderInclude mortgagee clause, mailing address and contact email List any applicable Additional Insured partyinclude mailing addressIs the property we're quoting a new build? No Yes How did they first hear about RiskWell? What else do we need to know? (Other lines of business, expectations, land mines, etc.)Attach any relevant documentsInsured will receive an automated email request for documents as well. Drop files here or Select files Max. file size: 98 MB.
