High Rise Insurance - Award Winning Brokerage

General Information

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Insured Name

This is the person's name who will be listed on the insurance policy also referred to as the "First Named Insured" or Primary Account holder.

Name

This is the person's name who will be listed on the insurance policy also referred to as the "First Named Insured" or Primary Account holder.

Date of Birth

This is the person's name who will be listed on the insurance policy also referred to as the "First Named Insured" or Primary Account holder.

Phone Number

Please enter a valid phone number

Email

example@example.com

Referral

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How did you hear about us?

Share your social media handle

Who referred you to us?

Referred by...

Let's be friends

Share your social media handle

Social media

Ex. @majdastouchinsurance

Other

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Secondary Named

This is the person's name who will be listed on the insurance policy also referred to as the "First Named Insured" or Primary Account holder.

Secondary Named Date of Birth

This is the person's name who will be listed on the insurance policy also referred to as the "First Named Insured" or Primary Account holder.

Community/Building name

Referred by...

Lease or Purchase

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Is this a Lease or Purchase?

Lease

Purchase

Please be advised that our insurance coverage for events where alcohol is served has a limitation on coverage extending until 2:00 AM. This means that any incidents or claims arising from the event will be covered until 2:00 AM local time on the designated event date.

Lease Information

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Lease start date

This is the person's name who will be listed on the insurance policy also referred to as the "First Named Insured" or Primary Account holder.

Legal names of each person on the lease

List each person's Legal Name listed on the Lease

Phone numbers for each person on the lease

Enter each person's cell phone number

Emails for each person on the lease

Enter each person's email address. In case of claims this is used for identity verification

Property Address

This is the person's name who will be listed on the insurance policy also referred to as the "First Named Insured" or Primary Account holder.

Residence Occupancy Type

Primary Residence, Seasonal, AirBnB, For Rent Long Term

Purchase Information

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Purchase date

This is the person's name who will be listed on the insurance policy also referred to as the "First Named Insured" or Primary Account holder.

Legal Name of each person on the title

List each person's Legal Name listed on the title

Phone number for each person on the title

Enter each person's cell phone number

Email for each person on the title

Enter each person's email address. In case of claims this is used for identity verification

Unit Property Address

This is the person's name who will be listed on the insurance policy also referred to as the "First Named Insured" or Primary Account holder.

Approximate sq footage of your unit

List square footage or number of bedrooms

Residence Occupancy Type

Primary Residence, Seasonal, AirBnB, For Rent Long Term

Final

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Do you have any special property you want to include?

Enter each person's cell phone number

My insurance renewal is in:

I agree to terms of engagement

Ex. I need Homeowners, Landlord, Auto...

Acknowledged and agreed by client:

Save

Clear

You are not required to pay for services or utilize our office to secure insurance services in exchange for obtaining your insurance policy. While you have chosen to collaborate with Majdas Touch Insurance, Inc., you are under no obligation to do so, and you retain the freedom to explore other brokerages without incurring any fees. The decision to continue paying this fee is entirely voluntary, and you are making it of your own accord and volition.

Majdas Touch

Towering Assurance, Elevated Peace

Protecting Your Towering Investments

Our Coverage Highlights

Let's Elevate Your Protection

@majdastouchinsurance