Florida Flood Insurance Quote

Full Name:          
Mailing Address:
City:
Florida
Zip Code:
Daytime Phone:     Ext.
Evening Phone: 
Cell Phone:           Fax:
(Email Address Required)
Flood Zone:
County:       

Building Occupancy: Select One Single Occupancy 2 to 4 Family Other Residential Non-Residential

Are you applying for this flood insurance policy on behalf of
the lender for the Mortgage Portfolio Protection Program?     Select One Yes No

Condo Association and Residential Building?                         Select One Yes No

Has property incurred 2 or more losses?                               Select One Yes No

Is property granfathered into a B, C, or X Zone?                   Select One Yes No

Select Policy Type: Select One Regular Preferred

Florida Flood Coverage Information:

Replacement Cost:           $
Total Building Coverage:  $
Total Contents Coverage: $

Building Type:        Select One 1 Floor Split-Level 2 Floors 3 or more Floors Townhouse/Rowhouse Manufactured Home
Construction Date:  (mm/dd/yyyy)
Number of units in building: Select One 0 1 2 3 4 5 or more
Condominium Association: Select One Yes No

Basement / Enclosure or Crawl Space:

Basement / Enclosure of Crawl Space: Select One None Basement Enclosure or Crawl Space
Does enclosure or crawl space area have compliant venting: Select One Yes No
Finished Area: Select One Yes No
Machinery / Equipment: Select One Yes No
Building Elevated:          Select One Yes No
Lowest floor which includes living
area, is off the ground by means of: Select One Piles Posts Piers Columns Solid Perimeter Walls Parallel Walls Other
Area used for:    Select One Parking Storage Access Other
Square foot area:
Enclosure Walls: Select One Breakaway Solid Perimeter Lattice Other

Contents Location: Select One Lowest Floor Only - Above Ground Level Lowest Floor Above Ground Level & Higher Floors Above Ground Level by 1 Floor of More

Miscellaneous Information:
Is building flood proofed: Select One Yes No
Wave height adjustment: Select One Yes No

Florida Flood Insurance Question:


Click on the "Submit Quote Request" button below to send
your Florida Flood Insurance quote request.**

**Information received from this Florida Flood Insurance quote request form
sent to "YOUR AGENCY NAME" will be for our use only and will not be
sold, given to or distributed to any other parties. A quote will be based
on the Florida flood insurance policy information provided and does not
guarantee acceptance of the risk by us. The precise coverage afforded
is subject to meeting underwriting guidelines, and the terms, conditions
and exclusions of the policy as issued. By submitting this request you
acknowledge that this is neither an offer to insure nor a guarantee of
insurance. Completion of this form does not entitle you to a Florida Flood
Insurance policy. We are licensed in Florida and will not provide flood
insurance quotes for other states.

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