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Property and Casualty
Wholesaler since 1965
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Step One: Complete Form
Step Two: Review and Submit
Step Three: Finish
Welcome to Earthquake E-Z Quote from A&M.

For fast service on your earthquake accounts complete the form below and hit the “Step Two” button. Your submission will be electronically delivered to the next available Underwriter.
 
Applicant Name:
Applicant Website Address:
Location address:
City: State: Zip Code:
Description of Risk:
Expiring Carrier:
 Willing to Renew?:
Renewal Quote:
Target Premium:
Deductible:
Property Information
Building:
Contents:
If Apt, # of units:
Building Shape: 
Square Feet:
Construction Type:
Loss of Income:
Number of Stories:
Tenancy?:
Primary Occupancy:
Parking Type:
 
 
If over 20 years old, provide building updates: Building Updates / (Year)
Year Built: Wiring (Yr):   Roof (Yr):   Heating/Air (Yr):   Plumbing (Yr):
Setbacks/Overhangs:
Building on 100% curcuit breakers?:
Earthquake sprinkler leakage?:
Mold clean-up and removal?:
    Comments & other Material Information:
     
Agency Name:
Contact Person:
Phone Number:
  Fax Number:
E-mail Address:
 
 
    (You will get a summary page to review before submitting)