Dear Prospective Client,
Thank you for contacting us for information regarding the services we provide. Enclosed you will find our new client management package which will provide you with all the information you need about our company and the services we offer.
Houston Management Company is a full service Property Management and Real Estate company which has been serving Orange County, Riverside County, Los Angeles County and Coachella Valley for over 24 years. We currently manage a variety of property types throughout Southern California.
As a full service property management company, we offer complete property management services. All of our services are provided at one low monthly fee based on gross receipts with no hidden costs or charges.
Each of our Property Managers are licensed Real Estate Agents who are knowledgeable, professional, prompt and courteous. As experienced real estate professionals we understand that your property is a valuable
investment. With that in mind, our primary goals are to:
Maximize Cash Flow – We are committed to maximizing your income by obtaining the maximum amount of rent possible according to current market conditions.
Minimize Vacancy Period – We are committed to minimizing the time that your rental is not generating income by creating and implementing a marketing plan that will focus on getting your property rented as quickly as possible. In addition, we do not charge for periods of vacancy.
Protect Your Investment – We are committed to protecting your investment by conduction thorough tenant screenings and vendor verifications.
Do The Work for You – We are committed to providing you with full service management by handling everything on your behalf so you can spend more time doing the things you enjoy!
Please review the enclosed management package and call us at 714-278-1855 if you have any questions or concerns. We hope that we can be of service to you and we look forward to hearing from you in the near future.
Sincerely,
Houston Management Company
1105 E. Commonwealth Avenue Suite G Fullerton, CA 92831 (714) 278-1855 Fax: (714) 278-1893
TABLE OF CONTENTS
Property Management Services ……….. 1
Frequently Asked Questions ………... 4
New Client Application ………... 5
Home Owner Insurance Verification Form ………. 11
PROPERTY MANAGEMENT SERVICES
Houston Management Company is committed to fulfilling all of your property management needs. Below is a list of services included in our full service management package. If there is a service you are interested in but cannot find it listed below, please call us at 714-278-1855. Our services can be tailored to fit any owner’s needs. Prompt, Courteous and Professional Service
As experienced real estate professionals, we strive to provide each of our clients and their tenants with professional, prompt and courteous service. Each of our licensed staff members treat all clients and tenants with dignity and respect.
Rental Preparation
Your Property Manager will visit the property to evaluate and make recommendations regarding the preparation of your property for the rental market.
Your Property Manager will coordinate and oversee the completion of all maintenance and repairs using our network of qualified vendors to ensure that all work is completed in a timely and professional manner.
Your Property Manager will focus on obtaining monthly rental amounts. Determine the Optimal Monthly Rental Amount
Your Property Manager will complete a detailed market analysis to determine the optimal rental amount for your property. This determination will be based on the current market value for like kind properties in the same geographical location as the subject property.
Create a Marketing Plan
Your Property Manager will discuss with you the variety of marketing options available to quickly rent your property and minimize vacancy periods.
Your Property Manager will plan and execute your personalized marketing plan by utilizing the Internet, Multiple Listing Services, local newspapers, circulars, flyers and property signs.
Your Property Manager will promptly pursue all leads and inquiries and schedule showings of your property during the week, evenings and weekends depending on the needs of the potential tenants. Applicant Screening Process
All applicants 18+ must submit a rental application and provide current picture identification in order to be considered as a potential tenant.
A professional screening company will be used to screen each applicant. This will ensure that all State and Federal Laws including Fair Housing Laws will be enforced. The applicant’s credit history, rental history including evictions, employment, income and criminal background will be reviewed. An approval, approval with requirements (such as co-signer or full deposit) or denial will be determined based on the results of the screening process.
All application fees (currently $35 per applicant) must be paid upfront directly by the applicant. The owner will not incur any expenses related to tenant screening.
New Tenant Move-Ins
Your Property Manager will prepare all rental and lease agreements utilizing California Association of Realtors approved forms.
Your Property Manager will discuss the expectations regarding rent payment and rules and regulations. Your Property Manager will meet with your new tenants and ensure all agreements have been properly reviewed and executed prior to his or her move-in.
Your Property Manager will collect the first month’s rent and security deposit in the form of a cashier’s check or money order prior to your tenant’s move-in.
Your Property Manager will perform a Pre Move-In Condition Inspection. This will document your property’s condition prior to move-in. Digital photography may also be used. This information can later be compared to the property condition at the end of the tenancy by utilizing the Move-Out Condition Inspection. Tenants are required to sign these forms for documentation and verification purposes. Your Property Manager will prepare a separate pet policy and pet addendum if pets are allowed. Some large breed dogs and other animals which are considered uninsurable under home owners insurance policies will not be permitted. All pet owners are required to submit proof current city registration, rabies and vaccine records and a photo of the animal.
Existing Tenant Move-Outs
Your Property Manager will insure that when a move-out occurs, that all necessary paperwork is completed.
Your Property Manager will provide your tenants with the opportunity to elect a Pre Move-Out
Inspection up to 14 days prior to the end of their tenancy. This will give the tenant an idea of what needs to be done in order to avoid deposit deductions and to help return the unit in its original condition. Your Property Manager will collect pro-rated rents for any partial months of tenancy.
Your Property Manager will make sure that all keys and remotes are returned and that a forwarding address is received.
Your Property Manager will schedule maintenance and make deductions to the vacating tenant’s security deposit according to state laws.
Your Property Manager will provide the vacating tenant with an itemized security deposit report along with copies of the receipts for repairs and a check or bill for the difference.
Rent Collection and Follow-Up
Your Property Manager will promptly collect your rental income at the beginning of each month. Your Property Manager will serve three day notices to “Pay Rent of Quit” if rent is not received by the end of the grace period outlined on the tenant’s rental or lease agreement.
Your Property Manager will coordinate the start of unlawful detainer actions to evict your tenant in the event there rent is not paid.
Payments of Your Monthly Expenses
Our Accounting Department will pay all reoccurring monthly expenses on your behalf such as: - Mortgages - Home Owners Association Dues - Property Taxes - Utilities
- Home Owners Insurance - Gardening and Pool Services Management fees are directly deducted from rental income prior to any other expenses. Detailed Monthly Accounting Reports
Our Accounting Department will provide you with monthly itemized statements showing income and expenses related to your property. Copies of all invoices will be provided.
Our Accounting Department will provide you with a year-end accounting summary of your income and expenses.
Our Accounting Department will disburse the rental proceeds in the manner instructed by you on a monthly basis. Funds can be mailed to your or directly deposited into a local financial institution of your choice.
Maintenance Services
We provide our clients with 24-hour emergency repair services.
We minimize the cost of repairs and maintenance using our experienced network of contractors, vendors and handymen.
We do not mark up the cost of maintenance. Copies of all invoices are provided to you monthly. We log and coordinate all maintenance including property reconditioning such as painting, window coverings, carpet cleaning and replacement, etc.
We research and coordinate all necessary services such as utilities, gardening and pool service. Property Management Fees
All property management packages are based on a percentage of gross receipts. This percentage is determined by the number of units, location, condition and marketability and rent ability of the property. Our fee schedules range from 4%-10% of monthly gross receipts. Maintenance, advertising and legal fees (if any) are paid separately.
There are no additional charges for lease renewals, notice generation and delivery, postage and supplies. Property management fees are generally deductable as a direct expense item. A tax advisor can be recommended for more information.
Additional Services
Additional services can be added on a case by case basis. Please call for details.
FREQUENTLY ASKED QUESTIONS
Below are a few of the most frequently asked questions that are most commonly asked by new clients. If you have a question that is not answered below, please contact us at 714-278-1855 for personal assistance.
Q: What is typically involved in preparing a property to be rented?
A: Generally, you should expect to make the property move-in ready for a tenant. This may involve painting or patch work, carpet cleaning or replacement, minor repairs, etc. Your property will rent quicker and demand a higher rental value if it is in good condition.
Q: What determines the optimal rental rate for my property?
A: Your Property Manager will complete a detailed market analysis to determine the optimal rental amount for your property. This determination will be based on the current market value for like kind properties in the same geographical location as the subject property. Property condition and marketability also plays a role in determining the optimal rental amount.
Q: Who pays for maintenance and repairs to my property?
A: The owner is responsible for maintenance and repairs, unless the tenant has caused damage outside of normal wear and tear. In that case, we will seek reimbursement on your behalf from the tenant. Because we deal with a large volume of properties, we can normally contract at considerable savings to you for repairs and maintenance. We save you money whenever possible and we do not mark up the cost of repairs and maintenance.
Q: Who pays for the marketing of my property?
A: Houston Management Company pays for all signage and labor costs related to marketing your property for rent. The owner pays for the cost of advertising the property for rent in local periodicals and the Multiple Listing Service (if chosen). For more information, please see the Advertising Options section in this management package.
Q: Are management fees deductable?
A: Generally, as a direct expense item. However, you should confirm this with your tax advisor as your specific situation may be different. A tax advisor can be recommended upon request.
Q: How are tenants selected?
A: All applicants 18+ must submit a rental application and provide current picture identification in order to be considered as a potential tenant. A professional screening company will be used to screen each applicant. This will ensure that all State and Federal Laws including Fair Housing Laws will be enforced. The applicant’s credit history, rental history including evictions, employment, income and criminal background will be reviewed. An approval, approval with requirements (such as co-signer or full deposit) or denial will be determined based on the results of the screening process.
Q: Do I pay for the processing of tenant applications?
A: All application fees (currently $35 per applicant) must be paid upfront directly by the applicant. The owner will not incur any expenses related to tenant screening.
Q: How are security deposits handled?
A: All security deposits are forwarded to the owner with that months income statement. When a notice to vacate is received, the last month’s rent will be held on file to be used for tenant deposit reimbursement. By law, all security deposit money due to the tenant must be refunded within twenty-one (21) days from the date of move out and receipts for repairs must be provided.
NEW CLIENT MANAGEMENT APPLICATION 5
NEW CLIENT MANAGEMENT APPLICATION
CLIENT INFORMATION
LAST NAME FIRST NAME MIDDLE NAME
PRESENT ADDRESS CITY STATE ZIP CODE
DATE OF BIRTH DRIVER’S LICENSE NUMBER STATE SOCIAL SECURITY NUMBER
HOME PHONE WORK PHONE CELL PHONE
EMAIL ADDRESS
SPOUSE OR PARTNER INFORMATION
LAST NAME FIRST NAME MIDDLE NAME
DATE OF BIRTH DRIVER’S LICENSE NUMBER STATE SOCIAL SECURITY NUMBER
PRESENT ADDRESS CITY STATE ZIP CODE
HOME PHONE WORK PHONE CELL PHONE
EMAIL ADDRESS
TAXPAYER IDENTIFICATION INFORMATION
LEGAL NAME OF ENTITY
LEGAL ADDRESS CITY STATE ZIP CODE
CONTACT NUMBER FEDERAL TAXPAYER IDENTIFICATION NUMBER (TIN)
MONTHLY ACCOUNT STATEMENT
PLEASE MAIL A PAPER COPY OF MY STATEMENT TO THE FOLLOWING STREET ADDRESS:
NOTE: IF YOU HAVE AN INVESTMENT PARTNER(S) WHO REQUIRES A SEPARATE MONTHLY PROPERTY STATEMENT AND IS ENTITLED TO RECEIVE A PROTION OF THE OWNER PROCEEDS, PLEASE CHECK THIS BOX AND FILL OUT SEPARATE FORMS FOR EACH PARTNER.
OWNER DEPOSIT OPTIONS – PROCEEDS DEPOSITED DIRECTLY INTO YOUR BANK ACCOUNT
NO – DO NOT SEND OWNER PROCEEDS TO MY BANK. SEND THEM TO THE ADDRESS LISTED ABOVE
YES – PLEASE SEND OWNER PROCEEDS TO MY BANK (FILL IN THE BLANKS BELOW). REPORT ANY CHANGES IMMEDIATELY
NEW CLIENT MANAGEMENT APPLICATION 6
DISPURSEMENT INFORMATION
HOUSTON MANAGEMENT COMPANY WILL PAY YOUR REOCCURING BILLS ON YOUR BEHALF. BELOW IS A LIST OF THE MOST COMMON OF THESE BILLS. PLEASE REVIEW EACH ITEM AND INDICATE WHEATHER YOU WANT TO PAY THE BILLS YOURSELF OR PREFER US TO PAY THE BILLS ON YOUR BEHALF.
1. MORTGAGE PAYMENT
OWNER WILL CONTINUE TO PAY DIRECTLY – PROOF OF PAYMENT MUST BE PROVIDED TO MANAGEMENT.
HOUSTON MANAGEMENT CO. WILL PAY ON OWNER’S BEHALF FROM FUNDS IN THE TRUST ACCOUNT. PAYMENT ADDRESS:
PAYMENT AMOUNT PAYMENT DUE DATE LOAN NUMBER
HOUSTON MANAGEMENT CO. WILL PAY ON OWNER’S BEHALF FROM FUNDS IN THE TRUST ACCOUNT. PAYMENT ADDRESS:
PAYMENT AMOUNT PAYMENT DUE DATE LOAN NUMBER
OWNER WILL CONTINUE TO PAY DIRECTLY – PROOF OF PAYMENT MUST BE PROVIDED TO MANAGEMENT.
2. SECOND TRUST DEED PAYMENT
HOUSTON MANAGEMENT CO. WILL PAY ON OWNER’S BEHALF FROM FUNDS IN THE TRUST ACCOUNT. PAYMENT ADDRESS:
PAYMENT AMOUNT PAYMENT DUE DATE APN NUMBER
OWNER WILL CONTINUE TO PAY DIRECTLY – PROOF OF PAYMENT MUST BE PROVIDED TO MANAGEMENT.
3. PROPERTY TAX PAYMENTS
$ _____________________ 1ST INSTALLMENT IS DUE ON THE 1ST DAY OF NOVEMBER – LATE IF RECEIVED AFTER THE 10TH DAY OF DECEMBER.
$ _____________________ 2ND INSTALLMENT IS DUE ON THE 1ST DAY OF FEBRUARY – LATE IF RECEIVED AFTER THE 10TH DAY OF APRIL.
PAYMENT AMOUNT NEXT PREMIUM DATE INSURANCE POLICY NUMBER
OWNER WILL CONTINUE TO PAY DIRECTLY – PROOF OF PAYMENT MUST BE PROVIDED TO MANAGEMENT.
4. INSURANCE PREMIUMS
HOUSTON MANAGEMENT CO. WILL PAY ON OWNER’S BEHALF FROM FUNDS IN THE TRUST ACCOUNT. NAME OF AGENCY:
PAYMENT ADDRESS:
HOUSTON MANAGEMENT CO. WILL PAY ON OWNER’S BEHALF FROM FUNDS IN THE TRUST ACCOUNT. PAYMENT ADDRESS:
PAYMENT AMOUNT PAYMENT DUE DATE ACCOUNT NUMBER
OWNER WILL CONTINUE TO PAY DIRECTLY – PROOF OF PAYMENT MUST BE PROVIDED TO MANAGEMENT.
OWNER WILL CONTINUE TO PAY DIRECTLY
HOUSTON MANAGEMENT CO. WILL PAY ON OWNER’S BEHALF FROM FUNDS IN THE TRUST ACCOUNT. PAYMENT ADDRESS:
PAYMENT AMOUNT PAYMENT DUE DATE ACCOUNT NUMBER
NEW CLIENT MANAGEMENT APPLICATION 7
6. GARDENER OR POOL SERVICE
TENANTS RESPONSIBILITY/TENANT PAYS
PAYMENT AMOUNT PAYMENT DUE DATE ACCOUNT NUMBER
7. UTILITIES: WATER
OWNER WILL CONTINUE TO PAY DIRECTLY
HOUSTON MANAGEMENT CO. WILL PAY ON OWNER’S BEHALF FROM FUNDS IN THE TRUST ACCOUNT. PAYMENT ADDRESS:
TENANTS RESPONSIBILITY/TENANT PAYS
PAYMENT AMOUNT PAYMENT DUE DATE ACCOUNT NUMBER
8. UTILITIES: ELECTRICITY
OWNER WILL CONTINUE TO PAY DIRECTLY
HOUSTON MANAGEMENT CO. WILL PAY ON OWNER’S BEHALF FROM FUNDS IN THE TRUST ACCOUNT. PAYMENT ADDRESS:
TENANTS RESPONSIBILITY/TENANT PAYS
PAYMENT AMOUNT PAYMENT DUE DATE ACCOUNT NUMBER
9. UTILITIES: GAS
OWNER WILL CONTINUE TO PAY DIRECTLY
HOUSTON MANAGEMENT CO. WILL PAY ON OWNER’S BEHALF FROM FUNDS IN THE TRUST ACCOUNT. PAYMENT ADDRESS:
TENANTS RESPONSIBILITY/TENANT PAYS
PAYMENT AMOUNT PAYMENT DUE DATE ACCOUNT NUMBER
10. UTILITIES: TRASH OR TRASH BIN RENTAL
OWNER WILL CONTINUE TO PAY DIRECTLY
HOUSTON MANAGEMENT CO. WILL PAY ON OWNER’S BEHALF FROM FUNDS IN THE TRUST ACCOUNT. PAYMENT ADDRESS:
TENANTS RESPONSIBILITY/TENANT PAYS
PAYMENT AMOUNT PAYMENT DUE DATE ACCOUNT NUMBER
11. OTHER:
OWNER WILL CONTINUE TO PAY DIRECTLY
HOUSTON MANAGEMENT CO. WILL PAY ON OWNER’S BEHALF FROM FUNDS IN THE TRUST ACCOUNT. PAYMENT ADDRESS:
NEW CLIENT MANAGEMENT APPLICATION 8
RENTAL PROPERTY INFORMATION
RENTAL ADDRESS CITY STATE ZIP CODE
NEAREST CROSS STREETS
TYPE
□
SINGLE FAMILY RESIDENCE□
CONDO□
TOWNHOUSE□
OTHER: ---IS TH---IS PROPERTY ATTACHED OR DETACHED?□
ATTACHED□
DETACHEDHOW MANY STORIES IS THIS HOME/UNIT
□
1□
2□
3IS THIS UNIT UPSTAIRS OR DOWNSTAIRS?
□
DOWNSTAIRS□
UPSTAIRSSQUARE FEET YEAR BUILT LOT SIZE SCHOOL DISTRICT
IS THIS RENTAL LOCATED IN A GATED COMMUNITY?
□
YES□
NO□
REMOTE CONTROL□
KEY□
GATE CODE ---GARAGE/PARKING INFORMATION
IS THERE A GARAGE?
□
YES□
NO HOW MANY STORIES IS THIS HOME/UNIT□
1□
2□
3□
4IS THE GARAGE ATTACHED?
□
YES□
NO ARE THERE ANY REMOTE OPENERS?□
YES□
NO IF SO, HOW MANY? --- IS THERE A CARPORT?□
YES□
NO IS THE CARPORT COVERED?□
YES□
NO IS THERE RV PARKING?□
YES□
NO ARE THERE ASSIGNED SPACES?□
YES□
NO HOW MANY? --- ARE THEY COVERED?□
YES□
NO ADDITIONAL PARKING INFORMATION: __________________________________________________________________________________________________ROOMS
BEDROOMS:
□
1□
2□
3□
4□
5 LIVING ROOM?□
YES□
NO KITCHEN?□
YES□
NO TOTAL BATHS:□
1□
2□
3□
4 FULL BATHS: --- ¾ BATHS: --- ½ BATHS: --- ¼ BATHS: --- DINING INFO – CHECK ALL THAT APPLY:□
DINING ROOM□
FORMAL DINING□
EAT IN KITCHEN□
BREAKFAST NOOK□
BAR ADDITIONAL ROOMS:□
FAMILY ROOM□
DEN□
BONUS ROOM□
GREAT ROOM□
OFFICE□
LOFT CHECK ALL THAT APPLY□
SITTING ROOM□
SUNROOM□
OTHER: ---KITCHEN
KITCHEN INFO:
□
REFRIGERATOR□
DISHWASHER□
RANGE OVEN - IS THE RANGE□
GAS□
ELECTRIC CHECK ALL THAT APPLY□
MICROWAVE□
GARBAGE DISPOSAL□
ISLAND□
TRASH COMPACTOR□
GRANITEADDITIONAL KITCHEN INFORMATION: __________________________________________________________________________________________________ WHO IS RESPONSIBLE FOR MAINTAINING THE KITCHEN APPLIANCES?
□
OWNER□
TENANTOUTDOOR AREAS
NEW CLIENT MANAGEMENT APPLICATION 9
AMENITIES
FIREPLACE?
□
YES□
NO TYPE?□
GAS□
ELECTRIC□
WOOD BURNING LOCATION? _---WASHER & DRYER HOOK-UPS?
□
YES□
NOIS THERE A COMMUNITY LAUNDRY ROOM?
□
YES□
NOSWIMMING POOL:
□
YES□
NO IS THIS A PRIVATE POOL LOCATED AT A SINGLE FAMILY RESIDENCE?□
YES□
NOLOCATION? _--- TYPE?
□
GAS□
ELECTRIC WASHER & DRYER IN UNIT?□
YES□
NO WHO IS RESPONSIBLE FOR MAINTAINING WASHER & DRYER?□
OWNER□
TENANTSPA/JACUZZI:
□
YES□
NO IS THIS A PRIVATE SPA LOCATED AT A SINGLE FAMILY RESIDENCE?□
YES□
NO ADDITIONAL AMENITIES:□
TENNIS COURT□
CLUBHOUSE□
FITNESS CENTER□
GYM□
BBQ CHECK ALL THAT APPLY□
BUSINESS CENTER□
GOLF COURSE□
PLAYGROUND□
LAKECHECK ALL THAT APPLY:
□
CARPET LOCATION: ________________________________________________________________□
VINYL LOCATION: ________________________________________________________________□
WOOD FLOORING LOCATION: ________________________________________________________________□
PERGO LOCATION: ________________________________________________________________□
CERAMIC TILE LOCATION: ________________________________________________________________□
OTHER: LOCATION: ________________________________________________________________FLOORING
COOLING/HEATING
COOLING
□
CENTRAL□
AIR CONDITIONING WALL UNIT□
OTHER: _________________________________________________HEATING
□
CENTRAL□
FORCED AIR□
OTHER: _________________________________________________DOES THE HOME HAVE ANY CEILING FANS?
□
YES□
NO IF SO, HOW MANY? _________ LOCATIONS: _____________________________LEASING INFORMATION
IS THE PROPERTY CURRENTLY AVAILABLE FOR LEASE?
□
YES□
NO LEASE TERMS:□
1 2 MTS□
6 MTS□
MTMWHAT DAY IS THE PROPERTY AVAILABLE FOR SHOWINGS? ____/_____/_____
WHAT IS THE PROPERTY AVAILABLE FOR MOVE IN? ____/_____/_____
MONTHLY RENT: $ _________________ SECURITY DEPOSIT: $ _________________ PET DEPOSIT: $ _________________
ARE PETS ALLOWED?
□
YES□
NO WHAT TYPE IS ALLOWES?□
CAT□
DOG□
---_HOW MANY? _---
WHAT SIZE DOG IS ALLOWES?
□
ANY SIZE□
MEDIUM (20 LBS MAX)□
SMALL (10 LBS MAX) OUTDOORS ONLY?□
YES□
NO
PROPERTY DESCRIPTION
NEW CLIENT MANAGEMENT APPLICATION 10
HIGHLIGHT ANY SPECIAL FEATURES OR DETAILS OF YOUR PROPERTY. THIS INFORMATION WILL HELP US ADVERTISE YOUR PROPERTY WHEN IT IS AVAILABLE: __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________ SPECIAL INSTRUCTIONS
HIGHLIGHT ANY INFORMATION THAT YOU FEEL IS INPORTANT, SO THAT WE CAN BETTER MANAGE YOUR PROPERTY:
HOME OWNER INSURANCE VERIFICATION FORM
Dear Owner,
It is required of our company that our property owners name Houston Management Company as an additional insured party on your Liability Insurance Policy. The required amounts are as follows:
$300,000.00 for a Condo or PUD.
$500,000.00 for a Single Family Residence.
$1,000,000.00 for a Single Family Residence with a pool or spa. Please complete this form and return it with the management package.
SUBJECT PROPERTY: _______________________________________________________________ _______________________________________________________________
OWNER(S): _____________________________ ___________________________
Print Name Print Name
_____________________________ ___________________________ Signature Date Signature Date
MY INSURANCE INFORMATION
_________________________________________ ________________________________________ Name of Insurance Company Street Address or PO Box
________________________________________ ________________________________________
Name of Agent City, State and Zip
_______________________________________ ________________________________________
Policy Number Phone Number
_______________________________________ ________________________________________ Extent of Liability Insurance Fax Number
HOME OWNERS INSURANCE VERIFICATION FORM 11