South Florida Insurance Center

Florida Condo and Renters

Quote Request Form

Name

 Mr.      Mrs.     Mr. and Mrs.    Ms. 

First Name  Middle Initial

Last Name                                    

Property Address

 Street Address:      

 Apt#                    

 City:                          Inside city limits? Yes  No 

 State:                   Florida  

 Zip Code:           

 County                Choose One Alachua Baker Bay Bradford Brevard Broward Charlotte Clay Citrus Collier Columbia Dade Desoto Duval Escambia Flagler Gadsden Gulf Hardee Hendry Hernando Highlands Hillsborough Indian River Jackson Jefferson Lake Lee Leon Madison Manatee Marion Monroe Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam St. Johns St. Lucie Santa Rosa Sarasota Seminole Sumter Suwanee Taylor Volusia Walton Washington

Condo Owners Only

New Purchase?

Yes  

No  

 Date of closing/purchase:   

Renters Only

New Lease?

Yes 

No   

 Lease effective date: 

Occupancy

  This apt/condo is or  will be:  Choose One my primary residence my secondary residence rented to others

  Less than one month of UNoccupancy expected annually

Check any and all months the apt/condo will be NOT be occupied at any time during the        month. Your best guess, if you're not sure.

If this is not a new purchase/lease, is it insured now? Yes  No 

If yes, are you being offered a renewal?  Yes  No    If no, what is the date of cancellation?

Tell Us About Your Unit

Cost to replace personal property  $

Cost to replace the interior (owned condos only)  $

This is the cost to replace floor, wall and ceiling coverings, as well as all cabinets and all other improvements

On what floor is your condo/apartment?

Protective Devices

Tell Us About Your Development

Name of your development:

Security in your development or building:

Tell Us About Your Building

Description of the building 

 Year Built 0000 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923   Townhouse? Yes  No  

 Number of Floors in the building 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26+   

 Number of units in the building 

Miscellaneous

Retired

Yes   No

Over age 55

Yes   No

Auto Insurance

 Who is your auto insurance company?

  (Home Insurance sometimes can be discounted if your car insurance is through certain carriers.)

Additional Information

E-mail  

Daytime Phone