Flood Insurance Quote Request If you live in a flood zone you may be required to get flood insurance for your home. Enter some information and we’ll get started on your flood insurance quote. Flood Insurance Quote Form Name (required) Send Your Current Policy Upload your current policy Supporting Documents Email (required) Phone Spouse’s Name Address Quote Type —New CoverageReplacement Coverage Do you currently have flood insurance? YesNo If you do have insurance, with which company? Note: If this is a policy with a standard company, the rates will be the same. If this is a bank forced policy, we can quote it. Building Description (primary/secondary/etc) Year Built # of Families Who is the home occupied by? OwnerTenant Do you have an elevation certificate? YesNo Style of home: RanchHI RanchSplit RanchCapeColonialVictorianTownhouse (End Unit)Townhouse (Middle Unit)Condo (End Unit)Condo (Middle Unit) If it’s a condo, what floor? If it’s a condo, does the association have a master policy? YesNo Is the building over water? YesNo Is the building under construction? YesNo If yes, is it walled and roofed? YesNo Number of floors (including basement) Foundation type Basement (Unfinished)Basement (Finished)Crawl SpaceSlabPilings / Posts / Piers If basement or crawl space, list any machinery or equipment (ie: furnace, hot water heater, washer/dryer, food freezer, other) If crawl space or basement, what is the height? Does any portion of the basement go below ground? YesNo Is there a garage? NoneDetachedAttached List any machinery or equipment in the garage (ie: furnace, hot water heater, washer/dryer, food freezer, other) Have you had any claims or losses in the past 5 years? YesNo If you had a claim, what was the date of the loss? If you had a claim, how much was paid out? Desired Insurance Amounts Dwelling coverage Dwelling deductible Contents coverage Contents deductible Is this policy required for a loan closing? YesNo If so, what is the closing date? If this is required for a closing, what is the bank requesting? Enclosure Information Needed for A or V Zones The lowest floor is elevated by: LatticePlywoodMasonry or Concrete BlocksWood Frame WallsSolid Perimeter Load Bearing WallsOther Enclosure Area Material LatticePlywoodMasonry or Concrete BlocksWood Frame WallsSolid Perimeter Load Bearing WallsOther If other, please describe Is this area used for any purpose other than building access, parking, or storage? YesNo Is this area finished space (more than 20 linear ft of finished wall, paneling, etc)? YesNo What is the total area of enclosure in square feet? Number of permanent openings (vents) within 1 ft above adjacent grade Total area of all permanent openings (vents) in square inches Comments