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3 - Condominium Unit Owners
In order to quote your new, or requote your existing, Condominiun Unit Owners Insurance, we will need the following information to accurately quote your coverage. We have over 21 companies writing home insurance in SW Florida, more than any other agent and we want to get you the absolute, rock bottom quote with every discount you qualify for. In order to do that, this information is necessary. If you can supply this information, I will immediately go to work for you.
ALL INFORMATION PROVIDED HERE WILL BE SENT to us SSL - SECURE SOCKET LAYER - ENCRYPTED for your security
Today's Date
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Name as on Deed
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Your Name:
*
Email
*
Who told you about us?
*
Date of Birth (over age 50 discounts available)
*
MM
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DD
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YYYY
Date of Birth (Spouse) (over age 50 discounts available)
MM
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Daytime Phone
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Cell Phone
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Property Location
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Name of Association
Current Insurance company
Coverage A - Dwelling Limit
(permanent fixtures)
Coverage C - Contents Limit
(personal property)
Renewal Date
MM
/
DD
/
YYYY
Reason for shopping
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Is this a new purchase?
*
Yes
No
If yes, Purchase Price needed...
Estimated closing date
MM
/
DD
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YYYY
Did you purchase as a Short Sale or a Foreclosure?
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Yes
No
Square footage under air
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Year Built
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Condo Construction
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Masonry Block
Frame (exterior walls)
Other
Type of roof
(ie: shingle, tile, etc.)
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# of stories
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Which floor is your unit located?
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# of Bedrooms
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# of Bathrooms
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Are you Homesteaded at this address?
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Yes
No
OWNER Occupied Months:
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Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
ALL 12 MONTHS
NONE
TENANT Occupied Months:
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Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
ALL 12 MONTHS
NONE
Protected Community?
Gated
24 Hour Manned
Remote
Rovers
Central Station Monitored and activated Alarm System?
*
Yes
No
Alarms
Burglar
Fire
Do you have flood coverage, with who?
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List animals owned
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Dogs
Cats
Non-domestic
None
Breed & bite history
Number of people living in unit:
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Is this unit for sale?
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Yes
No
Foreclosures, bankruptcies, or repossessions, last 5 years?
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Yes
No
ANY losses/claims at ANY location (reported or not) in the past 5 years?
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Yes
No
If yes, provide details, date, and amount paid:
Any Business conducted at unit (ie: office, daycare, etc.)
*
Yes
No
Do you own any of the following?
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Golf Cart
Watercraft
Motorcycle
None
Attach copy of insurance dec page
Attach copy of Wind Mitigation from Association
Who is your Auto Insurance Company?
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