For 2-10 PadSplit Properties

Speak To An Agent

If you have questions or concerns about insuring your PadSplit property, you can schedule a call with one of our agents using the button below. You’ll be taken to our booking page, where you can choose a time and date that works best for you.

Schedule A Call

Contact Information

Policy Holder Name

Billing Address

City

State

Zip

Contact Name

Phone Number

Alternative Phone Number

Years In Business

Has applicant ever filed for bankruptcy?

Property Information

Property Title Holder

Property Address

Property City

Property State

Property Zip

Year Built

Construction Type

Square Footage

# Doors/Rooms

Annual Rents

Do you have a Mortgage?

+ Add Property #2

Property 2 Title Holder (if different)
Property 2 Address
Property 2 City
Property 2 State
Property 2 Zip
Property 2 Year Built
Property 2 Construction Type
Property 2 Square Footage
Property 2 # of Doors/Rooms
Property 2 Annual Rents

+ Add Property #3

Property 3 Title Holder (if different)
Property 3 Address
Property 3 City
Property 3 State
Property 3 Zip
Property 3 Year Built
Property 3 Construction Type
Property 3 Square Footage
Property 3 # of Doors/Rooms
Property 3 Annual Rents

+ Add Property #4

Property 4 Title Holder (if different)
Property 4 Address
Property 4 City
Property 4 State
Property 4 Zip
Property 4 Year Built
Property 4 Construction Type
Property 4 Square Footage
Property 4 # of Doors/Rooms
Property 4 Annual Rents

+ Add Property #5

Property 5 Title Holder (if different)
Property 5 Address
Property 5 City
Property 5 State
Property 5 Zip
Property 5 Year Built
Property 5 Construction Type
Property 5 Square Footage
Property 5 # of Doors/Rooms
Property 5 Annual Rents

+ Add Property #6

Property 6 Title Holder (if different)
Property 6 Address
Property 6 City
Property 6 State
Property 6 Zip
Property 6 Year Built
Property 6 Construction Type
Property 6 Square Footage
Property 6 # of Doors/Rooms
Property 6 Annual Rents

+ Add Property #7

Property 7 Title Holder (if different)
Property 7 Address
Property 7 City
Property 7 State
Property 7 Zip
Property 7 Year Built
Property 7 Construction Type
Property 7 Square Footage
Property 7 # of Doors/Rooms
Property 7 Annual Rents

+ Add Property #8

Property 8 Title Holder (if different)
Property 8 Address
Property 8 City
Property 8 State
Property 8 Zip
Property 8 Year Built
Property 8 Construction Type
Property 8 Square Footage
Property 8 # of Doors/Rooms
Property 8 Annual Rents

+ Add Property #9

Property 9 Title Holder (if different)
Property 9 Address
Property 9 City
Property 9 State
Property 9 Zip
Property 9 Year Built
Property 9 Construction Type
Property 9 Square Footage
Property 9 # of Doors/Rooms
Property 9 Annual Rents

+ Add Property #10

Property 10 Title Holder (if different)
Property 10 Address
Property 10 City
Property 10 State
Property 10 Zip
Property 10 Year Built
Property 10 Construction Type
Property 10 Square Footage
Property 10 # of Doors/Rooms
Property 10 Annual Rents

Underwriting Information

Do you make physical inspections of the properties?

How often are inspections made?

Who performs the inspections?

Do inspections include safety and physical hazards at each location (i.e. entryways, stairs, railings for loose boards, bricks, stones, handrails)?

How quickly are repairs made?

Are vacant* properties secured and inspected?

How long are units vacant between tenants?

*the policy requires vacant locations to be secured and inspected monthly

Prior Coverage & Loss History

Do the additional units have current/prior coverage?

Please list all losses the past 5 years (date of loss, type, amount paid, and open/closed status).

Final Steps

Applicant's Name

Applicant's Title

Application Date

*Please ensure you see the on-screen confirmation message in a green box after submitting your application.*

2026 Single Source Insurance

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