Investor Contact Form

Please fill out this form and we will be in touch with your shortly.

Kish North

kish@btcins.com

* Required field(s)

Investor Details

Estimated Effective Closing Date*(Required)

Estimated Effective Closing Date*

Who is submitting ?*

Who is submitting(Required)

Client

Lender

Submitters Contact Information*

Hidden

Agency Email(Required)

Name/Entity Name(Required)

Name/Entity Name

Your Email(Required)

Phone Number(Required)

Phone Number

Business Address(Required)

Business Address

City(Required)

City

State(Required)

State

ZIP Code(Required)

ZIP Code

If entering a company name, this is the insured on the policy

Investor Address*

Entity/Investor Name(Required)

Entity/Investor Name

Investor Email

Investor Number(Required)

Investor Number

Street Address(Required)

Street Address

City(Required)

City

State(Required)

State

ZIP Code(Required)

ZIP Code

Property Information

Subject Property Address*

Property Information: Subject Property Address(Required)

Subject Property Address

Property Information: City(Required)

City

Property Information: State(Required)

State

Property Information: ZIP Code(Required)

ZIP Code

County

Property Details*

Project Type(Required)

Project Type

Occupied or Vacant(Required)

Occupied or Vacant

Occupied

Vacant

Cost of Rehab(Required)

Cost of Rehab

Property Type(Required)

Property Type

No. of Units(Required)

No. of Units

Construction(Required)

Construction

Area (in sq. ft.)(Required)

Area (in sq. ft.)

Monthly Rents(Required)

Monthly Rents

Year Built(Required)

Year Built

Year Built(Required)

Year Built

Electrical(Required)

Electrical

Your most recent plumbing renovation (drop down)

Your most recent plumbing renovation

Current age of roof (drop down)

Current age of roof

Square Footage Add

Flood Insurance(Required)

Are you in a flood zone/Would you like a flood quote?

Yes

Coverage Details*

Hidden

Binder for Closing(Required)

Hidden

6-month or 1-year Policy(Required)

Hidden

Sewer Backup Coverage(Required)

Hidden

Ordinance or Law Coverage(Required)

Hidden

Property is Escrowed(Required)

Do you have any current damages?(Required)

Do you have any current damages?

Any loss on this property in the last 3 years?(Required)

Any loss on this property in the last 3 years?

Please provide loss data(Required)

Please provide loss data

Do you have a builder’s risk endorsement?(Required)

Do you have a builder’s risk endorsement?

Coverage Amount(Required)

Coverage Amount (Replacement cost used)

Include contents up to 20%, if desired

Lender/Additional Insured Loss Payee

Lender/Additional Insured Name(Required)

Name

Lender/Additional Insured Address(Required)

Address

Lender/Additional Insured Zip(Required)

ZIP

Lender/Additional Insured Name

Name

Lender/Additional Insured Address

Address

Lender/Additional Insured Zip

ZIP

Lender/Additional Insured Phone(Required)

Phone

Lender/Additional Insured Email(Required)

Lender/Additional Insured Phone

Phone

Lender/Additional Insured Email

Loan No.(Required)

Loan No. (If you don’t have a loan, you can write N/A)

Loan No.

Loan No. (If you don’t have a loan, you can write N/A)

Additional Attachments

Drop files here or

Max. file size: 200 MB.

Comments

Additional Emails

Additional Email 1

Please add additional emails you would like to have this form sent to

Additional Email 2

Additional Email 3

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BTC Insurance can provide you with an insurance quote for your business or personal insurance needs.

Serving: Utah Based

Licensed to conduct Business in following States

About BTC Insurance

For more than a decade, BTC Insurance has been committed to serving the insurance needs of the Utah community. Our approach is not only to provide you with insurance products that fit your exposures but to also help you put into place loss control and safety measures to mitigate and minimize losses. This takes experience and expertise – exactly what you will find with BTC Insurance.