AFM-Apt – Qubit Quote

Tell us about yourself

Your Name: *

Your Email: *

Your Phone Number: *

Building Number: *

Apartment Letter: *

Apartment Street: *

Start Date: *

Plan: *

Please add your spouse or partner's information

Their name: *

Their email: *

Their phone number: *

Application

Please read the following statements and confirm. All statements are required to be true in order to continue policy quote.

None of the named insured or additional insured filed for bankruptcy or had a bankruptcy discharge in the past 5 years.

None of the named insured received a felony charge or conviction in the last 7 years.

For this application and future renewals, you authorize the Company and its affiliates to collect and use information from consumer reporting agencies for all named insureds and additional insureds, such as loss histories and credit history reports.

None of The Named Insureds Applying For Coverage Been Canceled Or Non-Renewed In The Last 5 Years.

There is no Child or Adult Care Conducted On The Premises

The covered Property is not being Subleased

Please check if you understand the following policy provisions.

Mandatory Endorsement For CaninesThe applicant agrees that liability coverages (Coverages L & M) have an aggregate sublimit of $5,000 when the following breeds of dog, whether that breed is in full or in part are owned by or in the custody of an insured: Pit Bull Terrier, Staffordshire Terrier, Rottweiler, German Shepherd, Presa Canario, Chow Chow, Doberman Pinscher, Akita, Wolf-hybrid, Mastiff, Cane Corso, Great Dane, Alaskan Malamute, Siberian Husky or any canine, regardless of breed, with a known history of biting or aggression. This sub-limit applies whether or not the canine(s) was in the care, custody, or control of an insured at the time of the application or subsequently added.

Mandatory Endorsement For PoolsThe applicant agrees that liability coverages (Coverages L & M) have an aggregate sub-limit of $5,000 when a slide, diving board or any other jumping apparatus is used in conjunction with an in-ground or above-ground swimming pool, wading pool, docks, beaches or bodies of water or an in-ground or above-ground swimming pool or wading pool that is not fenced with at least a 4-foot high fence and with a locking gate. This sub-limit applies whether or not these conditions exist at the time of the application or they are subsequently added.

Trampoline ExclusionThe applicant agrees that this policy provides no Coverage L, Coverage M or a duty to defend by the Company for claims arising out of the ownership, the control of or the use of trampolines wherever located. This exclusion applies whether or not a trampoline is owned by, in the control of, or in the use by an insured at the time of the application or the trampoline is subsequently added.

Policy Confirmation

Summary

I hereby certify that I am a human being and I have the authority to make this request by accurately filling out my own personal information. I agree that when I click the "Start Policy" button, Alamance Farmers' Mutual will create a policy and send me a bill.

Please enter your name to confirm.