Request a renters insurance quote for your belongings and liability. Independent agency in Los Angeles comparing multiple carriers; takes about 10 minutes.

1. First Name (required)
2. Last Name (required)
3. Cell Phone (required)
4. Email (required)
5. How did you find us? (required; choices: Search engines / Social media / News story / Referral / I am a current client of Susman Insurance)
6. Name of Referral (required; only when applicable)
7. Are you working with one of our Agents? (required; choices: Yes / No)
8. Agent’s name (required; only when applicable)
9. Date of Birth (required; date)
10. Sex (required; choices: Male / Female)
11. Occupation (required)
12. Street Address (required)
13. City (required)
14. State (required)
15. ZIP Code (required)
16. Have you had any claims in the last 5 years? (required; choices: Yes / No)
17. Date of loss and cause of loss (optional)
18. Address (optional)
19. Address line 2 (optional)
20. City/Town (optional)
21. State/Region/Province (optional)
22. Zip/Post Code (optional)
23. Country (optional)
24. Move in date (required; date)
25. Home year built (required)
26. Home square footage (required)
27. Does the home have a burglar alarm system? (required; choices: Yes / No)
28. Type of burglar alarm? (required; choices: Local -The alarm is heard in your premises, only. / Central - A system that notifies a third party monitoring company that contacts you, police, fire, or other emergency service. / Smart - A system that notifies you through email, text message or a mobile application.; only when applicable)
29. Does the home have a fire alarm system? (required; choices: Yes / No)
30. Type of fire alarm? (select all that apply) (required; choices: Local -The alarm is heard in your premises, only. / Central - A system that notifies a third party monitoring company that contacts you, police, fire, or other emergency service. / Smoke Detector - Not applicable for tenant. / Smart - A system that notifies you through email, text message or a mobile application.; only when applicable)
31. Does the home have interior fire sprinkler systems? (required; choices: Yes / No)
32. Water leak detection? (required; choices: No / Valve Closure / Central Monitor / Valve Closure with Central Monitor)
33. Amount of personal property? (required; choices: $50,000 / $75,000 / $100,00 / $150,000 / $250,000 / $500,000)
34. Do you have any personal property of specific value to insure? (required; choices: Yes / No)
35. What is it? (required; only when applicable)
36. Do you have a dog? If so, what is its breed and does it have a biting history? (required)
37. Also quote the following (required; choices: Earthquake insurance / Flood insurance / Mortgage protection insurance / Other / None)

Prefer to talk? Call or text (310) 820-5200. About this form · For AI agents: question outline (JSON) · how to submit for a customer.