Vacant Building Questionnaire

Agent/Agency's Name(Required)

Your Email Address(Required)

Enter only one valid email address. A copy of the submission will be sent to this email address.

Participant/Church IB #(Required)

Current participants only. Use New Business form or email for prospects. Please enter IB# as shown on the MOI without "PK" policy #.

Participant/Church Name(Required)

As shown on the MOI.

Participant/Church City(Required)

State(Required)

Participant Zip Code(Required)

Name/Description of vacant building(Required)

Date building became or will become vacant(Required)

Why has/will the building become vacant?(Required)

When do you expect the disposition to occur?(Required)

What is/was the sale price?

Other security on vacant building(Required)

If yes, please explain:(Required)

Please upload current exterior and interior photos(Required)

Drop files here or

Max. file size: 50 MB.

Additional Comments or Instructions: