REIQR - RiskWell

Name(Required)

First Last

Business Name(Required)

Brief description of business operations(Required)

Business Address(Required)

If you want to specify a mailing address different from your location address, please let us know in your Discovery call.

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

What can we help you with?(Required)

File Upload

Please upload any documents needed for us to be able to deliver you an ideal outcome.

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1Contact Info

2Property 1 Info

3Property 2 Info

4Property 3 Info

5Property 4 Info

6Wrap-up Info

How many separate properties do you need a quote for right now?*

If you need quotes for more than 15 properties, please email REI@riskwell.com and we will personally assist with your request.

Are you a current client of RiskWell?*

What effective date do you want for your new insurance?*

Please note, we are not able to backdate coverage. Today's date is the first available day for coverage to begin.

Your Name*

Your Date Of Birth*

Is the property held in your personal name or another legal entity (LLC, etc...)*

Entity Name*

Phone Number*

Email*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Physical Address - Property 1*

Street Address Address Line 2 City State ZIP Code

County - Property 1

Building Type - Property 1*

*Please note we are not able to provide coverage for mobile manufactured homes*

# Of Units - Property 1*

Tell us the number of units that you own/need coverage for.

Intended Use - Property 1*

Building Coverage Amount Needed ($) - Property 1*

For a "flip" property, use the purchase price + your renovation estimate to determine the property coverage amount.

Monthly Rent - Property 1*

Purchase Method - Property 1*

Creative Financing Method - Property 1*

Policy Payment Method - Property 1*

Note that if you select "title company or escrow account" you will be required to enter lender/mortgagee information.

Lender/Mortgagee - Property 1?*

Lender/Mortgagee Name - Property 1*

Please provide the full name of the lender.

Lender/Mortgagee Email - Property 1*

Input the primary contact email for the lender/mortgagee

Lender/Mortgagee Mailing Address - Property 1*

Street Address Address Line 2 City State ZIP Code

Full name and mailing address for underlying seller - Property 1*

Physical Address - Property 2*

Street Address Address Line 2 City State ZIP Code

County - Property 2

Building Type - Property 2*

# of units - Property 2*

Intended Use - Property 2*

Building Coverage Amount Needed ($) - Property 2*

For a "flip" property, use the purchase price + your renovation estimate to determine the property coverage amount.

Monthly Rent - Property 2*

Purchase Method - Property 2*

Creative Financing Method - Property 2*

Policy Payment Method - Property 2*

Note that if you select "title company or escrow account" you will be required to enter lender/mortgagee information.

Lender/Mortgagee - Property 2?*

Same Lender/Mortgagee For Property 2 As With Property 1?

Lender/Mortgagee Name - Property 2

Please provide the full name of the lender.

Lender/Mortgagee Email - Property 2

Input the primary contact email for the lender/mortgagee

Lender/Mortgagee Mailing Address - Property 2

Street Address Address Line 2 City State ZIP Code

Full name and mailing address for underlying seller - Property 2*

Physical Address - Property 3*

Street Address Address Line 2 City State ZIP Code

County - Property 3

Building Type - Property 3*

# of units - Property 3*

Intended Use - Property 3*

Building Coverage Amount Needed ($) - Property 3*

For a "flip" property, use the purchase price + your renovation estimate to determine the property coverage amount.

Monthly Rent - Property 3*

Purchase Method - Property 3*

Creative Financing Method - Property 3*

Policy Payment Method - Property 3*

Note that if you select "title company or escrow account" you will be required to enter lender/mortgagee information.

Lender/Mortgagee - Property 3?*

Same Lender/Mortgagee For Property 3 As With Property 1?

Lender/Mortgagee Name - Property 3

Please provide the full name of the lender.

Lender/Mortgagee Email - Property 3

Input the primary contact email for the lender/mortgagee

Lender/Mortgagee Mailing Address - Property 3

Street Address Address Line 2 City State ZIP Code

Full name and mailing address for underlying seller - Property 3*

Physical Address - Property 4*

Street Address Address Line 2 City State ZIP Code

County - Property 4

Building Type - Property 4*

# of units - Property 4*

Intended Use - Property 4*

Building Coverage Amount Needed ($) - Property 4*

For a "flip" property, use the purchase price + your renovation estimate to determine the property coverage amount.

Monthly Rent - Property 4*

Purchase Method - Property 4*

Creative Financing Method - Property 4*

Policy Payment Method - Property 4*

Note that if you select "title company or escrow account" you will be required to enter lender/mortgagee information.

Lender/Mortgagee - Property 4?*

Same Lender/Mortgagee For Property 4 As With Property 1?

Lender/Mortgagee Name - Property 4

Please provide the full name of the lender.

Lender/Mortgagee Email - Property 4

Input the primary contact email for the lender/mortgagee

Lender/Mortgagee Mailing Address - Property 4

Street Address Address Line 2 City State ZIP Code

Full name and mailing address for underlying seller - Property 4*

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What do you need help with?*
What kind of property is this?*
Property address you need quoted*
Street Address Address Line 2 City State ZIP Code
Who is listed as owner of the property?*
Your name*
First Last
Legal name of entity that owns this property*
Legal name of business*
Phone*
Email*

Real Estate Investor Quote Request