National Flood Insurance Quote
This information is necessary to quote National Flood Insurance policy backed by FEMA. These questions are required to get the most accurate, low cost policy.
Name: *
Property Address: *
Property City: *
Property State: *	Select Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Property Zip: *
Property County or Parish: *
Home Phone Number: *
Work Phone Number:
Email Address: *
Classify structure to be insured: *	Select Home/Dwelling Condo Apartment Mobile Home Business
Estimated Date of Construction (MM/YYYY) : *
Predominant Building Material: *	Select Brick Veneer Solid Brick Wood Frame Stucco Shingle Cement Block Prefab Metal Plastic Siding Aluminum Siding Rock/Stone Steel Logs Other
Number of Stories: *	Select One Two Three or more
Garage on Property: *	Select Attached Detached Carport No Garage
Number of Vehicle Stalls: *	Select One Car Two Car Three Car More than Three No Garage
1st Floor Square Footage (Approximate): *
2nd Floor Square Footage (Approximate):
Requested Dwelling Coverage Amount: *
Requested Contents Coverage Amount (Indicate "0" if not requested): *
Requested Deductible: *	Select $500 $1000 $1500 $2000 $2500 $5000 1% 2%
New Purchase or Refinance?: *	Select New Purchase Refinance First Time Flood Insurance Buyer Renewing Flood Insurance
New Home Construction?: *	Select No, Existing Home. Yes, New Construction.
Do you Have Survey or Has one Been Ordered?: *	Select Yes, Have one. Survey has been ordered No Survey
Do You Have an Elevation Certificate?: *	Select Yes, Have One No Elevation Certificate Certificate ordered Not sure what it is.
Requested effective date (for New Purchases and Renewals): *

Flood Insurance Quote-Final
These next questions may sound strange, particularly if you have never had flood insurance before. The questions help us qualified for the Preferred Risk Program.
Have you ever had 2 Flood Insurance Claim Payments, Each over $1000?: *	Select Yes No
Have you ever had 3 Flood Insurance Claim Payments, regardless of amount?: *	Select Yes No
Have you ever had 2 Federal Disaster Relief Payments (including loans and grants), each over $1,000?: *	Select Yes No
Have you ever had 3 Federal Disaster Relief Payments (including loans and grants), regardless of amount?: *	Select Yes No
Have you ever had 1 Flood Insurance Payment AND1 Federal Disaster Relief Payments (including loans and grants),each over $1,000?: *	Select Yes No