Glidewell Investments & Insurance Group, Inc.

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MINISTRIES: New Building

Please complete the form below to better serve your request. Incomplete forms may cause a delay in processing request.

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*Insured Name:
Policy Number:
*Building Street Address:
*City:
*State:
*Zip Code:
*Estimated Building Value:
*Estimated Building Contents Value:
*Type of Construction:
*Year of Construction:
*Primary Use of Building:
*Miles to Fire Hydrant:
*Total Ground Floor Square Footage:
*Total Building Square Footage:
*Basement Square Footage:
*Number of Stories:
*Pews Attached:
*Type of Heating System:
*Central Air Conditioning:
*Age of roof:
*Date of last roof maintenance:
*Number of Fire Extinguishers:
*Is the Building Sprinklered:
*Automatic Extinguishing System over cooking surfaces:
*Alarms / Smoke Detectors on each Floor:
*Heat Detectors:
*Pull Alarms:
*Central Detectors:
*Burglar Alarms:
*Building locked when not in use:
Additional Information:

By selecting "Submit", you agree to provide Glidewell Investments & Insurance Group, Inc., with information about you and/or your organization, that you are an authorized agent and/or representative of the organization submitting this request, and you have the authority to submit this request. In addition, the information provided by you, in this online form, is accurate. You furthermore agree that a representative of Glidewell Investments & Insurance Group, Inc., may contact you in the manner so indicated above. We appreciate your communication!

Securities offered through SIS Financial & Insurance Services.
777 108th Ave. N. E., Bellevue, WA 98004, Tel: (800) 469-7667
Glidewell Investments & Insurance, Inc., is not a subsidiary or an affiliate of SIS Financial & Insurance Services