Owner's Name:
Physical Street Address of Collection:
City:
State:
State (select one):
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
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Kansas
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Louisiana
Maine
Maryland
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Phone Number [Required - We will ONLY call you if there is a problem with your information or to give you the quote. ] (Our Promise : We will not solicit you or sell your phone number
Email Address [Required - We need this to email you the quote. ] (Our Promise : We will not solicit you or sell your email address .)
What type of collectibles do you have and what is the total combined value of that collection?
$
Coins
:
$
Furs
:
$
Rare Books, Comics & Manuscripts
:
$
Antique Firearms
:
$
$
Fine Art & Posters
:
$
Silverware
:
$
Wine & Spirits
:
$
Musical Instruments
:
$
Rugs & Tapestries
:
$
Stamps
:
$
Nototal combined value of that collection?:
Is Any One Item Valued at Over $2,500?:
NoOne item?:
Type of Location/Premesis where Collectibles are Stored:
Location Security:
Yes
No Central Station Fire Alarm?:
Yes
NoCentral Station Burglary Alarm?:
Yes
No
Other Location/Premesis Information:
Distance To Fire Station (Miles):
Is your location within 1,000 feet or less of a fire hydrant?:
Yes
NoIs the location within 1 mile of a major body of water?:
Yes
No Is any of your collection stored in a basement or other area below ground floor?:
Yes
NoIs the location in a designated flood zone?:
Yes
No Has location suffered water damage?:
Yes
No
Is your current collection insured with AXA Art Insurance Corporation?:
Yes
No
Has your collection insurance coverage been cancelled, declined, refused, or non-renewed in past 5 years?:
Yes
No
Have you filed for bankruptcy in the past 5 years?:
Yes
No
Any collection losses in the past 5 years?:
Yes
No
This is being quoted with a Zero ($0) Deductible. Would you like another deductible amount?:
Yes
No
Additional Information:
Additional Comments:
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