Home Question - E Policy Review

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Is this a new purchase? *

Closing date of home. *

Will this home have a mortgage? *

Name of lender & contact information.

Name

First

Last

Phone

Wind Mit & 4-Points
Both attached
I will email them to you
They are scheduled
Bank requiring Flood Insurance
I need to discuss this with you

Upload

Click or drag a file to this area to upload.

Name of realtor & contact information

Name

First

Last

Phone

Wind Mit & 4-Points
Both attached
I will email them to you
They are scheduled
I need help getting inspections
N/A - This is a new construction

Upload

Click or drag a file to this area to upload.

Style of Home *

Occupancy *

What is your current address?

Current Address *

Address Line 1

City

State / Province / Region

Years at address *

Purchase address *

Address Line 1

City

State / Province / Region

Purchase Price *

Style of Home *

Single Family
Condo
Townhome
Mobile
Manufactured
Multi Family 1-4 units

Any Claims in the past 5 years for any property you own or owned? *

Upload your current homeowner’s insurance policy.

Click or drag a file to this area to upload.

Attached
I will email them to you

Do you have a current Wind Mitigation & 4-Point Inspection ?

Upload

Click or drag a file to this area to upload.

Both attached
I will email them to you
They are scheduled

Are you being non renewed or depopulated from Citizens?

Upload your non-renewal letter or Citizen’s depopulation notice & quote from new insurance company

Click or drag a file to this area to upload.

Attached
I will email them to you

Let's get some info about the applicant

Please list yourself and each person who will be on the policy

First Name *

Last Name *

Date Of Birth *

Email address *

Phone number *

Industry *

Occupation *

Education *

Marital Status *

Gender *

Male
Female

Would you like to add another applicant

Please list yourself and each person who will be on the policy.

First Name *

Last Name *

Date Of Birth *

Email *

Phone

Industry *

Occupation *

Education *

Marital Status *

Gender *

Male
Female

Home is in Gated Community? *

Manned Security entrance? *

Do you have flood insurance? *

Flood Risk *

Yes, I want a Flood insurance quote
No thanks, I'll take the risk

Homeowners Insurances does NOT cover flood damage.

Claims in the past 5 years for any property you own or owned?

Roof original to home

Roof Installation Year?

Year of last electrical update?

Is Home under construction? *

Is the Home vacant? *

Year of last AC unit update?

Cooling Type *

Heating type *

Year of last Plumbing update?

Year of last electrical update?

Year of last water heater update.

Water heater Tank or tankless

Location of water heater

Do you have a bulglar alarm? *

Burglar alarm is monitored centrally by a company? *

Do you have a fire alarm? *

Fire alarm is monitored centrally by a company? *

Does home have a Garage? *

Attached
Detached

Number of cars that fit in garage. *

Does home have a Pool? *

Do you have a slide or diving board? *

Does Home have a trampoline? *

Does home have wood burning fireplace? *

Does home have solar panels on roof? *

How many panels? *

Do you have any of these dog breeds below? *

Additional details

Consent *

I grant permission for Epolicyreview.com and its, agent’s, representatives, relevant affiliates, and subsidiaries to communicate about my insurance needs today and in the future. I also grant permission for all relevant parties to speak with my realtor and/or loan officer/ about my insurance needs.

Home Questions

Name of lender & contact information.

Name of realtor & contact information

What is your current address?

Do you have a current Wind Mitigation & 4-Point Inspection ?

Let's get some info about the applicant

Would you like to add another applicant

quick links

services

get in touch