Add/Delete/Change Property Listing

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1 Start 2 Complete

* Denotes a Required Field

MUNICIPALITY/MEMBER INFORMATION

Municipality/ Member: *

Member Contact's Full Name: *

Member Contact's Position/ Title: *

Member Contact's Email Address: *

Member Contact's Phone Number: *

Member Contact's Fax Number:

PROPERTY CHANGE OPTIONS

Type of Property Change: *

Please Describe Details of Corrections/Changes in Comments or Details Section Below

Property Address: *

Effective or Termination Date?

Date: *

Month

Day

Year

PROPERTY INFORMATION

Description of Building: *

Building Use: *

Department:

Is Building Vacant?

Yes

Sprinklered?

Yes

Construction Type:

Building Value($):

Building Replacement Value($):

Contents Value ($):

Contents Replacement Value($):

Number of Employees in Building:

Number of Vehicles Garaged:

Property Inspection Contact Information:

Comments or Details: *

Would you like to upload a supporting document? (e.g. detailed property description)

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx odt ppt pptx xls xlsx.

Add a Second Property?

Yes

Fill Out The Information Below To Add a Second Property Change