Keller-Lowry Insurance, Inc. Serving Colorado's Insurance Needs Since 1972
 
Keller-Lowry Insurance, Inc.

1777 S. Harrison Street, Suite 700
Denver, Colorado 80210

Phone:
Toll Free:
Fax:
  (303)756-9909
(800)753-9909
(303)756-8818

 
 
 
Trusted Choice

 
Personal Inland Marine Insurance Quote

We would like to provide you with a free, no-obligation insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Account Representative / Referral
Please select your account representative,
or leave as "General Representative"
if you do not have one:
Referred By / To:

 
Personal Information
Applicant's Name:
Address:
City:   State:   Zip:
Day Phone:   Night Phone:
Best Time To Call:   AM   PM
Email Address:

 
Applicant & Location Information
 
Age:
Marital
Status:
 
Occupation:
Spouse's
Occupation:
Territory
Code:
Protect
Class:
Fire District/
Code #:
S
Location of Property
(if different from above):
Dwelling
Type(s):
Construction
Type(s):
# Families
(in each):

Additional Location
Other:

 
Coverages
Please indicate additional property that is not listed in boxes 10-14
#
Property
Amount of Ins.

#
Property
Amount of Ins.
  1 Jewelry $ 8 Coins $
2 Furs $ 9 Golfer's Equipment $
3 Fine Arts $ 10 $
4 Cameras $ 11 $
5 Musical Instruments $ 12 $
6 Silverware $ 13 $
7 Stamps $ 14 $
Unattended Car Coverage (Stamps/Coins)
Broad Form Pair & Set Coverage
Non-Mobile Organ Coverage
Safe Credit (Identify Property, Safe Class, Etc)
  ACV Loss Settlement
Replacement Cost Loss Settlement
Breakage Coverage (*On Schedule)
Blanket Coverage
Additional Rating Information

 
General Information
Explain All "Yes" Responses in Remarks
Yes/No

Explain All "Yes" Responses in Remarks
Yes/No
1. Any protective devices/systems in use? Y
N
6. Any other insurance with this company? Y
N
2. Will any property be exhibited? Y
N
7. Did any loss occur during the last 3 years? Y
N
3. Will any special restriction/ endorsements apply? Y
N
8. Any coverage declined, cancelled or non-renewed during the last 3 years? Not applicable in MO Y
N
4. Will any type of deductible apply? Y
N
Prior Insuror & Policy Number
5. Is any property used professionally/ commercially? Y
N
Remarks

 
Schedule of Property
#
Provide a detailed description of each item, from whom purchased, etc. Be sure to forward all required appraisals/bills. Purchase/
Appraisal Date
Amount of Insurance
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Please use the "Additional Comments" section at the bottom of this form for additional entries.

 
Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you
have additional information where there was not enough fields above, such as
additional coverages, schedule of property, etc..., please enter them here.


Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

   

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