Name
First Name
Last Name
Name of Second Owner if Applicable
Address of the property
Select a city below for the property.
Naples
Bonita Springs
Fort Myers
Golden Gate
Other
Date of Birth of First Owner month/day/year
Date of Birth Second owner month/day/year
Best phone number to reach you:
If you would like to be contacted by email please provide the email address:
Select how many months occupied
1
2
3
4
5
6
7
8
9
10
11
12
1year+
Does your property have an alarm system (please check all that apply)
how the condo is/or will be occupied
Primary
Secondary
Rented to Other annually
Rented to Other seasonally
Other family will stay full time.
How many units in your building?
What floor is your unit located?
What is the name of your condo association?
What year was your building constructed?
Construction Exterior Walls
Concrete Block / Stucco
Poured Concrete
High Rise condo concrete
Wood Frame
Roof Construction Type if Known
Tile
Asphat Shingle
Metal
Concrete
Other
Please estimate square footage of the unit under air:
Dwelling Coverage (recommend $50 per square foot or 20% of the purchase price whichever is greater)
Personal Property Coverage Limit Desired:
Liability / Guest Medical Pay
$100,000/$1,000
$100,000/$5,000
$300,000/$1,000
$300,000/$5,000
$500,000/$5,000
Loss Assessment Desired:
$2,000 minimum required by law
$3,000
$4,000
$5,000
$10,000
$25,000
$50,000
$100,000
Deductible Desired
$500 all peril / $500 hurricane
$500 all peril / 2% hurricane
$1000 all peril /2% hurricane
$2500 all peril /2% hurricane
$1000 all peril / No hurricane desired
Please indicate the name of your current insurance company, if none state none, if new purchase state new purchase:
Do you Have any Allstate Policies?
*
If you anwsered yes to previous question, please provide your allstate policy number(s).
Please Verify one of the Following
Choose an Option
New Purchase
My Homewoners insurance has expired less than 30 days ago
My homeowners insurance has expired over 30 days ago
We will do our best to get the quote out to you in 24 hours Monday - Friday. Thank you.
Claims in the past three years?
Do you have any dogs? If yes please describe the dog's breed.
How did you find us?
Received a Mailing
Referred to your office
Looked us up on the internet
Current Customer
Other
Does your condo have polybutylene piping?
No
Yes
Not Sure
Please enter estimated year of hotwater heater below.
Do you rent the unit to others? If so how many months?
Not Rented
Rented to Others 1-3 months
Rented to Others 4-8 months
Rented to Others 8-11months
Rented to Other Annually (A year or more)
Have you had any property insurance claims in the past three years?
If yes please provide date of loss, claim cause, amount paid if any.
Have you lived at the property to be quoted MORE than 2 years?
Yes
No
If you have lived at the property to be quoted for LESS than two years please provide your last or prior address?
