Partners Mutual Insurance Company Fillable Forms
FIRE INSURANCE APPLICATION M U T U A L I N S U R A N C E Tel Fax 262.798.5050 262.798.5040 20935 Swenson Drive Waukesha, Wisconsin 53186-2057 Insured Account Number: ___ Billing option: 1-pay 2-pay 4-pay Monthly [ Annual policy term needed ] for 2-pay, 4-pay, or Monthly Deposit amount submitted with application: $ ___ (Deposit Amt: 2-pay, 50% ann. premium; 4-pay, 25% ann. premium; Monthly, 2/12 ann. premium) No. of Pictures Attached ___ 1. APPLICANT Mailing Address Premises Occupation 2 MoreName. Street Address. City, State, Zip Code. 7. EXPLAIN THE FOLLOWING “YES” ANSWERS ON REVERSE SIDE IN REMARKS SECTION. YES. NO a. Any claims (losses) in Less
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