Legacy Wealth Management Group, Fiduciary, Investment Management, RIA, Lynchburg, Virginia, Educational Seminar, Riskalyze, Independent Financial Advisor - Homeowners Insurance : Quote Request

Legacy Wealth Management Group, Inc. (LWMG) is an SEC registered investment adviser located in Lynchburg, VA. LWMG and its representatives are in compliance with the current filing requirements imposed upon SEC registered investment advisers by those states in which LWMG maintains clients. LWMG may only transact business in those states in which it is registered or qualifies for an exemption or exclusion from registration requirements. LWMG’s web site is limited to the dissemination of general information pertaining to its advisory services, together with access to additional investment-related information, publications, and links. Accordingly, the publication of LWMG’s web site on the Internet should not be construed by any consumer and/or prospective client as LWMG’s solicitation to effect, or attempt to effect transactions in securities, or the rendering of personalized investment advice for compensation, over the Internet. Any subsequent, direct communication by LWMG with a prospective client shall be conducted by a representative that is either registered or qualifies for an exemption or exclusion from registration in the state where the prospective client resides. For information pertaining to the registration status of LWMG, please contact the SEC or the state securities regulators for those states in which LWMG maintains a notice filing. A copy of LWMG’s current written disclosure statement discussing LWMG’s business operations, services, and fees is available from LWMG upon written request or at https://adviserinfo.sec.gov/firm/brochure/322235 (LWMG’s CRD# is 322235). This information can also be found on the FORM CRS. LWMG. LWMG does not make any representations or warranties as to the accuracy, timeliness, suitability, completeness, or relevance of any information prepared by any unaffiliated third party, whether linked to LWMG web site or incorporated herein, and takes no responsibility, therefore. All such information is provided solely for convenience purposes only and all users thereof should be guided accordingly.


» Name:
Address:
City:
State:
Zip:
» Home Phone:
Work Phone:
» Email:
Age:

Insurance Type:	Single Family Townhouse Condo Renters
If multi-family bldg, how many residential units:	1-4 5-12 12+
Construction Type:	Frame Masonry Masonry Veneer
Year Built:
Nearest Fire Hydrant:	under 1000 feet none
Nearest Fire Department:	1 2 3 4 5 5+ miles
Smoke Detector:	Yes No
Deadbolt Locks:	Yes No
Fire Extinguisher:	Yes No
Central Station Fire Alarm:	Yes No
Central Station Burglar Alarm	Yes No
Swimming Pool:	Yes No
If yes, is it fenced in:	Yes No
Wood Burning Stove:	Yes No
Do you have a dog:	Yes No
Market Value $:
Existing dwelling coverage amount $:
Desired Coverage Amount $:
Liability Limit $:
Deductible:	250 500 1000
Any special coverages:
Current Insurance Company:
Expiration date (or settlement if new purchase):
Any claims past 5 years:
Please use the space below to add comments regarding any special circumstances.