"*" indicates required fields 123456 Let's Get Started First up, what property would you like insured? Address you want to insure* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Do you currently live here* Yes No Date you'd like the policy to begin* MM slash DD slash YYYY About You Just the basics for now. Name First Last PhoneDate of Birth MM slash DD slash YYYY Email Is there a Co-applicant? Yes No Co-applicant's Name First Last Co-applicants Date of Birth MM slash DD slash YYYY Co-applicant's Email About Your Home Let's learn about your property. Year BuiltSquare FootageNumber of Stories1 Story1.5 Story2 Story2.5 Story3 StoryBelow GradeBi- LevelTri-LevelRoof materialArchitectural ShinglesAsphalt/Fiberglass ShinglesBuilt-up Tar and GravelClay TileConcrete TileHail Proof (Impact Resistant)Mission TileSlateTinWood Shakes/ShinglesFoundation TypeSlab at Grade (Most Common in Florida)Crawl SpaceBasement UnfinishedPiersSuspended Over HillsideBasement Partially FinishedBasement Finished Property Details We need a few more details on your home. Home Purchase Date MM slash DD slash YYYY How is this home occupied Primary residence Seasonal residence Vacant Long-Term rental Is this residence rented out for any portion of the year? Yes No How many people are living in your home?Do you have a mortgage or loan on this property? Yes No Do you share your home with any of the following? Partner, Kids, Dogs, Cats Yes No Property Features & Condition What's condition of your home? Year roof was installedRoof conditionGoodNeeds repairLocated in a Gated Community? Yes No Do you have a swimming pool? Yes No Is your residence within 1,000 feet of a fire hydrant? Yes No Finishing Touches A few more questions. Marital StatusSingleMarriedDivorced or SeparatedWidowedEmployment StatusEmployedUnemployedSelf-employedHighest Level of EducationSome high schoolHigh school graduate, diploma or the equivalentSome collegeAssociate degreeTechnical or occupational certificateBachelor’s degreeMaster’s degreeDoctorateProfessionalNone of the AboveCAPTCHAEmailThis field is for validation purposes and should be left unchanged.
