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'Coverage Amount Requested' is the amount required to cover the complete replacement of your house.

Applicant Information Name Phone Email   Property Location Address Address Line 2 City State FL LA Zip Code   Coverage Information Current Coverage? --Select-- Yes No New Purchase Current Carrier Current Policy Expiration Month  --Select-- 1 2 3 4 5 6 7 8 9 10 11 12                      Year  --Select-- 2012 2013 2014   Current Premium Amount Reason for Quote --Select-- Being non-renewed Just shopping around Coverage Amount Requested   Building Information Dwelling Type --Select-- Single Family Townhouse Condo Usage --Select-- Primary Home Second Home/Beach House Rental Property Central Burglar/Fire Alarm? Occupancy --Select-- I live in the dwelling I rent the dwelling to tenants Year Built Request a Deductible --Select-- $1,000/2% $2,500/2% Not Sure Construction --Select-- Masonry Frame Square Footage Less than 1,000 feet from fire hydrant? Less than 5 miles from fire department? Within city limits? Do You have a Pool? If Yes, is the Pool Screened? Additional Notes