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Flood Insurance

GEDMINAS INSURANCE and FINANCIAL SERVICES

This is not an instant quote website; our prices are too low to list online. Please fill out the quote form to obtain a Flood insurance quote, and an insurance specialist will contact you shortly. Please understand this is not an application for insurance. An application will be sent to you if coverage is desired.

* Required Information

Flood Fact Finding Questions

Of the following, what is the primary reason for flood insurance?	Requesting More Information
	Loan Required
	Replace Investment

In the order of importance, what is most important to you?	Price
	Service
	Proper Coverage

Approximately, when was the last time you did a review with your agent?	Within the year
	Over 2 years ago
	Over 5 years ago
	Never

How much out of pocket expense could you afford if your home were destroyed?	$

Would you be interested in going to higher deductibles to reduce your premium?	Yes
	No

Personal Information

First Name

Last Name

Gender

Male Female

Date of Birth

Marital Status

Occupation

Home Address

Zip Code

Best Time to Call

Home Phone

Work Phone

Cell Phone

Fax

* Email Address

Home Information

Home Types

Residence Types

Dwelling Replacement Cost:

Year Built:

Construction Type

Roof Type

Number of Stories

SquareFeet of House

Number of Bedrooms

Number of Bathrooms

Fireplace

Garage Types

Central Air Conditioning:	Yes No

Flood Information

Flood Zone

Residence Types

Number of Floors

Is Building a Condominium?

Yes No

Condominium Specifications

Number of Units

Is Property located in an unincorporated area of county?

Is the Building in the course of construction?

Yes No

Is building State Government Owned?

Yes No

Is this policy required for Disaster Assistance?

Yes No

Do You Have an Elevation Certificate?

Yes No

Does the Garage Contain Machinery or Equipment?

Yes No

Machinery or equipment in Garage?
Furnace	Air Conditioner
Heat Pump	Fuel Tank
Cistern	Washer & Dryer
Elevator Equipment	Hot Water Heater
Food Freezer	Other

Is machinery or equipment elevated to the Base Flood Elevation?

Is the garage used for any purpose other than building access (stairwells, elevators, etc.), parking, or storage?

Yes No

Location of Contents:

Yes No

Flood Coverage Information

Dwelling Protection Requesting: (Max $250,000)

Building Deductible:

Contents Coverage Requested:

Contents Deductible

Location of Contents:

Additional Information: