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FLOOD INSURANCE
Submitted by
insureitsmart
on Mon, 03/25/2019 - 07:23
1
Start
2
Complete
ABOUT YOU
First Name
*
Middle Name
Last Name
*
Email
*
Street Address
City
State
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Phone(Day)
Phone(Evening)
Fax
YOUR FLOOD INSURANCE INFORMATION
Is this insurance quote for
Homeowners
Renters
IF THIS INSURANCE QUOTE IS FOR HOMEOWNERS
Year Purchased
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2022
2023
2024
2025
2026
Purchase Price
$
Loan Amount
$
IF THIS INSURANCE QUOTE IS FOR RENTERS
Do you currently have flood insurance?
Yes
No
Monthly Rent
$
IF YOU ANSWERED 'YES' TO HAVING FLOOD INSURANCE
When does your current policy expire?
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
Who are you currently insured with?
How much is your home insured for?
Coverage Amount?
$
Content Coverage Desired?
Approximate Interior Square Footage
sq.ft.
Approximate Year Built
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Is your home located within 5 miles of a fire station?
Yes
No
Is your home built on a hillside ?
Yes
No
Is your area prone to landslides and/or sinkholes ?
Yes
No
Have you experienced any losses or filed any claims within the last 5 years ?
Yes
No
How many rooms?
- None -
5
5 1/2
6
6 1/2
7
7 1/2
8
8 1/2
9
9 1/2
10
10 1/2
11
11 1/2
12
12 1/2
13
13 1/2
14
14 1/2
15
Flood Zone
- None -
A
A1-30/AE
AH
AO
A99
V
V1-30/VE
B,C, & X
D
Not Sure
How many living in the residence ?
- None -
1
2
3
4
5+
Do you have a basement ?
- None -
No Basement
Unfinished
Partly Finished
Fully Finished
Slab
Do you have a pool ?
- None -
No
Above Ground
Below Ground
Other
How many bedrooms ?
- None -
1
1 1/2
2
2 1/2
3
3 1/2
4
4 4 1/2
5
5+
Type of exterior wall
- None -
Adobe
Aluminum/VinylSiding
Asphalt
Brick Veneer
Cement Fiber
Clap Board
Concrete Block
Log Siding
Logs
Mineral Fiber
Painted Masonry
Precast Concrete
Precast Stone
Slump Block
Split Block
Solid Brick
Solid Stone
Stone Veneer
Stucco on Frame
Stucco on Masonry
Wood Shakes
Wood Siding
Other / Not Sure
Age of Roof ?
- None -
1 year old
2 years old
3 years old
4 years old
5 years old
6 - 10 years old
10 - 15 years old
15 - 20 years old
20 -25 years old
25 - 30 years old
30+ years old
Rate your own credit
- None -
Excellent
Minor problems
Bad
Horrible
Number of stories?
- None -
1
2
3
4
5
6
Over 6
Who lives in this residence ?
- None -
Owner
Renter
Under Construction
Vacant
What part of the year is the home occupied ?
- None -
Year Round
Seasonal
Never
How many bathroom ?
- None -
1
1 1/2
2
2 1/2
3
3 1/2
4
4 4 1/2
5
5+
How many fireplaces
- None -
1
2
3
4
5+
Type of roof
- None -
Architectural Shingles
Asphalt or Fiberglass Shingles
Built-Up/Tar and Gravel
Clay Tile
Concrete Tile
Corrugated Steel
Mineral
Fiber Shakes
Mission Tile
Rock Roof
Roll Roof
Rubber Roof
Slate
Tin
Wood Fiber Shingles
Wood Shake
Other / Not Sure
Type of foundation
- None -
Crawl Space
Piers/Pilings/Stilts
Slab on Grade
Walkout Basement
Wood Foundation Basement
Unfinished Basement
Other / Not Sure
OTHER DETAILS
Any Comments / Questions?
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