Flood Insurance Quote Request

Name (required)

Upload your current policy

Supporting Documents

Email (required)

Phone

Spouse’s Name

Address

Quote Type
—Please choose an option—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?

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?

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

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