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
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
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?
Sports Memorabilia :
$
[Value]
Toys :
$
[Value]
Coins
:
$
[Value]
Furs
:
$
[Value]
Rare Books, Comics & Manuscripts
:
$
[Value]
Antique Firearms
:
$
[Value]
Film & Theater Memorabilia :
$
[Value]
Fine Art & Posters
:
$
[Value]
Silverware
:
$
[Value]
Wine & Spirits
:
$
[Value]
Musical Instruments
:
$
[Value]
Rugs & Tapestries
:
$
[Value]
Stamps
:
$
[Value]
Vinyl LP's, CD's, Cassettes, Etc. : $
[Value]
Any
Other Collectibles Not Noted Above?:
Yes
No
If "Yes", what type of collectible and what is the total combined value of that collection?:
[Item Type & Description] : $
[Value]
Is Any One Item Valued at Over $2,500?:
Yes
No
If "Yes", what Item (Short Description) and what is the value of that One item?:
[Item Type & Description] : $
[Value]
[Item Type & Description] : $
[Value]
[Item Type & Description] : $
[Value]
[Item Type & Description] : $
[Value]
[Item Type & Description] : $
[Value]
Type of Location/Premesis where Collectibles are Stored:
Single Family Home
Apartment/Condo
Self-Storage
Other
If "Other", where is the collection located:
Location Security:
Deadbolt Locks on all Exterior Doors?:
Yes
No
Central Station Fire Alarm?:
Yes
No
Central Station Burglary Alarm?:
Yes
No
Other Location/Premesis Information:
Year the Structure was Built:
Distance To Fire Station (Miles):
Is your location within 1,000 feet or less of a fire hydrant?:
Yes
No
Is 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
No
Is 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
If "No", what is the name of your current insurance carrier?:
$
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
If "Yes", what deductible amount would you like?:
$
[Options: $100, $250,
$500,
$1,000,
$2,500,
$5,000]
Additional Information:
Additional Comments:
Please let us know how you found us :
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Other: