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Condominium
Name Insured
First MI. Last
*
Email Address
*
Property Address
Street
*
City, State, ZIP
*
Mailing Address
*
Select One
Same as above
Other
Contact Numbers
Home Phone
*
Business Phone
*
Property Facts
Year Built
*
Number of Stories
*
Number of Floors in Building
*
Number of Units in Building
*
Floor your unit is located on
*
Residence
*
Select One
Primary
Secondary
Seasonal
Seasonal with Rental
Annual Rental
Rental
Square Footage
*
Construction
*
Select One
Frame
Masonry
Gated Comunity
*
Select One
Yes
No
Alarm System
*
Select One
None
Local Alarm
Monitored Alarm
Storm Shutters
*
Select One
Yes
No
Attached Garage
*
Select One
1 car
2 car
3 car
4 car
Current / Prior Insurance
Prior Insurance Carrier
*
Premium
*
Coverage Value
Dwelling
*
Personal Property
*
Personal Liability
*
Regular Deductible
*
Select One
250
500
1,000
2,500
5,000
Hurricane Deductible
*
Select One
500
2%
3%
5%
10%
Describe any claims in the last 3 years
*
