Client Service Form / Info Use this form to efficiently submit service information to us! Please use one form/link per change. Company/Entity/Account Name*Contact Name* First Last Policy Number*Your unique policy number, found on your invoice.Contact Phone*Contact Email* I would like to:*Add a propertyDelete a propertyWhat kind of change would you like to make?*Change the Coverage AmountChange the Property Type/Occupancy StatusChange the Mortgagee/3rd PartyOther - Please describe in the "Other changes" box belowEffective Date of Addition/Change/DeletionMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Property Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificState ZIP Code OTHER ChangesSubmit any other change requests not listed above, pertinent closing instructions, etc... here.What do you intend to do with this property? Start renovation in 60 days or less Keep as a vacant property for more than 60 days Keep as a rental property (occupied in 60 days or less) Force-placed: Occupied location and unable to obtain current proof of coverage from borrower Force-placed: Vacant location and unable to obtain current proof of coverage from borrower Other (specify below) OtherUnitsEnter the # of units for this location here.Coverage amount requested*Enter the requested amount of coverage for this location.Loss of Rents Amount Requested*If this coverage is desired, enter the monthly rent amount. If not applicable, enter "0".Other Structures amount requested*Enter the requested amount of coverage for other structures, like a detached garage. Coverage only provided if scheduled. If not applicable, enter "0".Coverage type requested*Replacement Cost (RC)Actual Cash Value (ACV)**Our policies require a minimum of $75 of coverage per square foot in order for a property to qualify for Replacement Cost.** Replacement Cost (RC) and Actual Cash Value (ACV) are methods used to determine the amount that will be paid for a loss, and how your loss settlement will be calculated. Please select the option that you feel is most appropriate. RC is briefly defined as the cost to replace the property on the same premises with a property of the same like, kind and quality. Whereas ACV is basically equal to the replacement cost MINUS any depreciation. In other words, RC repairs/replaces, less the deductible, but ACV settlements are reduced by depreciation (which takes into consideration age, wear and tear, and condition BEFORE the deductible is applied. Though ACV may be less expensive than RC (the acceptable values are lower), remember that your settlement is subject to DEPRECIATION. Many times, especially with single family dwellings, the premium difference between the ACV and RC options is negligible. If desired, contact us to discuss your specific situation.Square footage*Enter the total square footage of the structure here.Year builtEnter the approximate or known original construction year of the property here.I have read and agree that this change is not in place until a confirmation email from realprotect is received.* I Agree Submitted By:* First Last EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.