Fair Rental Value (FRV) Form

For Insurance Agents Only

*Email Address:
*Damaged Property Address:
*City , *State AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY , *Zip
*Estimated Sq.Ft. of damaged home:
*Number of Acres of home lot:
Year Home was built:
Purchase price of home:
Year purchased home:
*How many levels of home: Single 2 Story
*Basement? Yes No ; Furnished Basement? Yes No
*Type of garage: 1 2 3 4 car
*# of BDRM: 1 2 3 4 5+
*# of BATHRM: 1 2 3+
Pool? Yes No , Spa? Yes No
Special Views? Yes No , Views of
Special Features:

Additional Info / Comments: