Location with contents

For customers, please complete the appropriate form below. Please note that submitting a change request does not bind coverage. Incomplete information may cause a delay in processing your request. Upon receipt of your request, we will contact you.

By clicking "Submit", you agree to provide Select Church Insurance Services with the submitted information about you and / or your organization, that you are authorized agent and / or representative of the organization, that you have the authority to submit this request, and that the information provided is accurate.

Ministry Name Ministry City 
Policy Number (Last 6 Numbers)
Date to start coverage 
New Location AddressStreet Address City State Zip County Inside City Limits
Primary Use
What is the Value of the contents at this Location?
Does Ministry Rent or Own BuildingTenant Improvements Coverage Required? (For Rentals Only)
If Yes, What Amount
Approximate Square Footage used by your ministry
Building InformationType of Construction
How many stories is this building
Roof Information
Approximate Roof Age
Approximate Age of Building
Approximate Age of Heating
Approximate Age of Plumbing
Approximate Age of Electrical
Does this location have a boiler that requires state inspection?Miles to Fire DepartmentDistance from Fire HydrantSprinkler System?Alarm Protection?If Yes, What type?Is there a Motion Detector?Are Alarms monitored by a Centralized Station?   

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