(760) 770-2827
Rancho Mirage, CA
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Flood Insurance Quote Form - Insurance Super Store
Flood Insurance Quote Form
Date:
Name:
Date of Birth:
Address:
Mailing Address same as Physical Address:
Y
N
Email:
Phone #:
Date Purchased:
Date Built:
Square Feet:
1 or 2 story:
1
2
Siding:
Roof Material:
Age of Roof:
Current Insurance:
Y
N
Current Insurance Co. Name:
Renewal or Non-Renewal Date:
Any claims last 5 years:
Y
N
Loss/Date/Amount:
Quote for loan closing:
Y
N
Multiple structures on property:
Y
N
Description and size:
Purchased within last year & prior owner had NFIP Policy:
Y
N
Building under construction:
Y
N
Building over water:
Y
N
Occupancy percentage:
50% or less
51%-75%
80% or more
Additions or extensions:
Y
N
Describe:
Substantial improvements since construction:
Y
N
Non-profit entity:
Y
N
Rental property:
Y
N
Prior NFIP Policy lapsed:
Y
N
Foundation:
Slab
Crawlspace
Elevators:
Y
N
Machinery & equipment elevated above 1st floor:
Y
N
Heat & A/C unit on roof:
Y
N
MAXIMUM BUILDING COVERAGE IS $100,000
Submit
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