South Florida Insurance Center

Florida Homeowners

Quote Request Form

Name

 Mr.      Mrs.     Mr. and Mrs.    Ms. 

 First Name  Middle Initial

  Last Name  

  Street Address:             

  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

  Yes  No  If yes, when do you expect to close?

If you currently own the home, is it insured now? Yes  No 

Single Family,

  Choose One Townhouse Single Family, unattached Other (Explain in remarks)

Purchase Price, if new purchase or Current Value of Property

Cost to Rebuild the House

 Year the house was built: Choose One 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  

Choose One CBS Frame Other, Please explain in remarks  If part CBS and part frame, check the one that is primary (0ver 50%).

Number of Sq. Ft. Under Air

  0 1 2 3 4 5 6 Bedrooms     

  0 1 1 1/2 2 2 1/2 3 3 1/2 4 4 1/2 5 5 1/2 6 6 1/2 Bathrooms   Choose One:  Standard  Upgraded  Designer 

Choose a category that best describes your bathrooms. If one is standard and  the other  designer, choose upgraded. 

Choose One:  Standard  Upgraded  Designer 

Choose the category that best describes your kitchen. It is common to  meet  parts of two different categories. Just do the best you can.

  List any and all extras such as intercom, solar panels, central vacuum, etc.

  Choose One None Yes, reports to a central station Yes, but does not report to a central station  

Hurricane Shutters

Who is your auto insurance company?

Home insurance quotations will include prices for hazard insurance, wind and hurricane insurance and flood insurance separately if necessary. Exact quotes for flood insurance require flood elevation certificates or flood surveys.