Service Request - 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)

Communication Authorization(Required)

RiskWell is authorized to communicate with me using the information provided for the purpose of delivering the requested information or solution. This communication may include phone, text or email. This authorization may be revoked at any time.

File Upload

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

Max. file size: 98 MB.

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"*" indicates required fields

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 that at this time 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*

Do you need a companion FLOOD INSURANCE quote for this property?*

How did you first hear about RiskWell?

Personal Referral

Google Search

McKinney Chamber of Commerce

Local event

Facebook Group/Post

YouTube video

Word of mouth

Who referred you to us?*

If this is a Rehab/Flip, are you acting as your own General Contractor for your deals?*

Your property insurance program DOES NOT cover construction liability. You need General Liability Insurance even if you're only acting as a GC on your own deals.

Our team is also well equipped to help with your Home and Auto insurance needs. After we're done with delivering this REI quote, can we review your personal insurance options?*

Date to contact you about reviewing your personal insurance

Please select the future date you want us to contact you on, so we can perform a full review of your personal insurance options.

What else do we need to know to deliver you an outstanding experience?

Communication Consent*

RiskWell is committed to respecting our current and future clients' privacy and communication preferences. So that we may remain compliant with state and federal regulations, we need your expressed permission to communicate with you using phone, text and email as needed.

You may opt-out of all future communication at any time by making your preferences known to us.

RiskWell operates by the simple rule of "treat other people the way you want to be treated."

I authorize RiskWell to communicate with me using the information provided on this form for the purpose of assisting with my insurance program..

Oops! We could not locate your form.

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*

Service Requests

Life is Risky. RiskWell.

PLEASE NOTE THAT ANY REQUEST FOR A BACK DATED CANCELLATION REQUIRES DOCUMENTATION TO BE APPROVED. PLEASE UPLOAD BELOW WHERE INDICATED.