FLOOD  INSURANCE  QUOTE We would like to provide you with a free, no-obligation flood insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only. General Information Name: Address: City:   State:   Zip: Day Phone:   Night Phone: Best Time To Call:   AM   PM Email Address: Property Address (if different): City:   State:   Zip: Current Flood Insurance Information Company Name (not agency): Policy Expiration Date:   Policy Type: Primary Secondary Home Information How Long At Present Address:     Year Home Was Built: Lender Name:     Lender Address:     Sq. Footage (excluding garage and basement): sq. ft.         # of Claims In Last 3 Years: Structure Information Type Construction Roof Foundation Garage 1 Story 1 1/2 Story 2 Story Split Level Bi-Level Other Frame Stucco Veneer Masonry Other Asphalt Shingle Wood Shingle Tile or Slate Other Basement Crawl Space Slab Other 1 Car 2 Car 3 Car 4 Car None Age of roof: yrs. Attached Detached Basement Built-in Car Port None Coverage Desired Deductible's: Dwelling: $500 $750 $1,000 $2,000 $5,000 Contents: $500 $750 $1,000 $2,000 $5,000 Dwelling Coverage: Select preset limit below: $25,000 $30,000 $35,000 $45,000 $50,000 $60,000 $65,000 $75,000 $85,000 $90,000 $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 Or enter your own limit (can't exceed $250,000): $ Contents Coverage  (Personal Property):  Select preset limit below: $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $45,000 $50,000 $60,000 $65,000 $75,000 $85,000 Or enter your own limit (can't exceed $85,000): $ Your Personal Property is Located:    Basement Only   Basement and Above   Lowest Floor only above ground level (basement not incl)   Lowest floor above ground level and above   Miscellaneous Information Do you qualify as a small business risk?: Yes     No Is building your principle residence?: Yes     No Is the building in the course of construction?: Yes     No Is insured property owned by state government?: Yes     No Is your building elevated?: Yes     No Is your building in a special flood hazard area? (if not certain leave blank): Yes     No FEMA (flood rate zone) (if not certain leave blank): A AE AH AO AR A99 D V VE X Other Not Known   Additional Comments Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough space, please enter them here. Please click on the "Submit Quote" button to send your quote request. One of our representatives will respond to your submission as soon as possible.