Elementor #7522 - E Policy Review

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Enter your home address to start your quote

Is this for new purchase or existing home?

Is lender requiring flood insurance.? *

Name of lender & contact information

Address of property requesting flood insurance *

Address Line 1

City

State / Province / Region

How long have you been at this address?

This will help us get an accurate quote

Years at address *

Enter address *

Address Line 1

City

State / Province / Region

Let's get some details on the property you're looking to insure

Type Of Home *

Occupancy *

Number Of Stories *

Whose name will be on this policy?

We need this information to get you an accurate quote

Name *

First

Last

Date Of Birth *

Marital Status *

Do you currently have flood insurance?

Has Flood Insurance *

Upload current policy

Click or drag a file to this area to upload.

Have you had any Flood Claims in the last 10 years?

We need to know if there have been any flood claims relevant to this address. *

Need date of loss & amount of loss *

Currently insured with Citizens & required to have flood Insurance *

Roof original to home

Year of last Plumbing update?

Year of last electrical update?

Year of last water heater update.

Water heater Tank or tankless

Location of water heater

Name *

First

Last

Email *

Phone number

Consent *

I grant permission for Epolicyreview.com & and its, agent’s, representatives, relevant affiliates, and subsidiaries to communicate about my insurance needs today and in the future. I also grant permission for all relevant parties to speak with my realtor and/or loan officer/ about my insurance needs.

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Is this a new purchase? *

Closing date of home. *

Will this home have a mortgage? *

Name of lender & contact information.

Name

First

Last

Phone

Wind Mit & 4-Points
Both attached
I will email them to you
They are scheduled
Bank requiring Flood Insurance
I need to discuss this with you

Upload

Click or drag a file to this area to upload.

Name of realtor & contact information

Name

First

Last

Phone

Wind Mit & 4-Points
Both attached
I will email them to you
They are scheduled
I need help getting inspections
N/A - This is a new construction

Upload

Click or drag a file to this area to upload.

Style of Home *

Occupancy *

What is your current address?

Current Address *

Address Line 1

City

State / Province / Region

Years at address *

Purchase address *

Address Line 1

City

State / Province / Region

Purchase Price *

Style of Home *

Single Family
Condo
Townhome
Mobile
Manufactured
Multi Family 1-4 units

Any Claims in the past 5 years for any property you own or owned? *

Upload your current homeowner’s insurance policy.

Click or drag a file to this area to upload.

Attached
I will email them to you

Do you have a current Wind Mitigation & 4-Point Inspection ?

Upload

Click or drag a file to this area to upload.

Both attached
I will email them to you
They are scheduled

Are you being non renewed or depopulated from Citizens?

Upload your non-renewal letter or Citizen’s depopulation notice & quote from new insurance company

Click or drag a file to this area to upload.

Attached
I will email them to you

Let's get some info about the applicant

Please list yourself and each person who will be on the policy

First Name *

Last Name *

Date Of Birth *

Email address *

Phone number *

Industry *

Occupation *

Education *

Marital Status *

Gender *

Male
Female

Would you like to add another applicant

Please list yourself and each person who will be on the policy.

First Name *

Last Name *

Date Of Birth *

Email *

Phone

Industry *

Occupation *

Education *

Marital Status *

Gender *

Male
Female

Home is in Gated Community? *

Manned Security entrance? *

Do you have flood insurance? *

Flood Risk *

Yes, I want a Flood insurance quote
No thanks, I'll take the risk

Homeowners Insurances does NOT cover flood damage.

Claims in the past 5 years for any property you own or owned?

Roof original to home

Roof Installation Year?

Year of last electrical update?

Is Home under construction? *

Is the Home vacant? *

Year of last AC unit update?

Cooling Type *

Heating type *

Year of last Plumbing update?

Year of last electrical update?

Year of last water heater update.

Water heater Tank or tankless

Location of water heater

Do you have a bulglar alarm? *

Burglar alarm is monitored centrally by a company? *

Do you have a fire alarm? *

Fire alarm is monitored centrally by a company? *

Does home have a Garage? *

Attached
Detached

Number of cars that fit in garage. *

Does home have a Pool? *

Do you have a slide or diving board? *

Does Home have a trampoline? *

Does home have wood burning fireplace? *

Does home have solar panels on roof? *

How many panels? *

Do you have any of these dog breeds below? *

Additional details

Consent *

I grant permission for Epolicyreview.com and its, agent’s, representatives, relevant affiliates, and subsidiaries to communicate about my insurance needs today and in the future. I also grant permission for all relevant parties to speak with my realtor and/or loan officer/ about my insurance needs.

Enter your home address to start your quote

How long have you been at this address?

Let's get some details on the property you're looking to insure

Whose name will be on this policy?

Do you currently have flood insurance?

Have you had any Flood Claims in the last 10 years?

Name of lender & contact information.

Name of realtor & contact information

What is your current address?

Do you have a current Wind Mitigation & 4-Point Inspection ?

Let's get some info about the applicant

Would you like to add another applicant

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