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Call Us: (800) 698-3966
California Office: 619-684-3811
New York Office: 516-308-4060
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Flood Insurance
Flood Insurance
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Primary Insured's Occupation:
Date of Birth
MM slash DD slash YYYY
Dwelling Information
Year Home Built:
Home Square footage:
Flood Zone Number
Flood Community Number
Type Construction:
Frame
Brick/Veneer
Stone
Other (list in remarks)
Type Roof:
Shingle
Wood Shake
Tar/Gravel
Spanish Tile
Metal
Other
Number of stories:
1
1.5
2
3
If more than 1 story, are some contents on ground floor, contents ONLY above the first floor?
If more than 1 story, are some contents on ground floor, contents ONLY above the first floor?
Ground Floor
Above first floor only
Currently Insured?
Currently Insured?
Yes
No
Prior Claims?
Plumbing type:
Copper
Galvanized
Mixed
Circuit Breakers/Fuses?
# Bedrooms:
# Bathrooms:
# Fireplaces:
# Fireplaces:
Special features (i.e., deck, air conditioning, alarm systems, pool, etc.)
Coverages
Dwelling Cov. $
Deductible $ ($250, $500, $1,000, etc.)
Contents $
Contents $
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