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Flood Insurance Quote
Policy Holder Information
Name(s) to appear on Policy
Mailing Address
City, State and Zip
Telephone Number
Fax Number
E-Mail Adddress

 

Property Information
Physical Address
City, State and Zip
Date of Construction
Name of Condo Complex / Project
Tax Map Key Number (TMK)
If your property does not have a TMK Number, please provide the following: Year built, square footage of living area, square footage of garage or carport, square footage of any lanais or porches, description and square footage of any other structures attached to the house.
Amount of coverage desired
for the structure
Amount of coverage desired
for the contents

 

Occupancy Information

 

Rental Property Information
Will you be renting any part of the property?
If so, how many tenants?
Short term or long term rentals?
Will the property be furnished?
Amount of coverage desired for furnishings

 

Other Information
Are there any structures requiring coverage that are not attached to the main building? (Detached garage, storage buildings, etc.)?
If yes, please provide details.
Any prior losses or claims in the ast 5 years?
If yes, please provide details.
Any other information you think may be pertinent, or, any questions or comments.

 

Portions courtesy of and © Insurance Information Institute (www.iii.org) Copyright © 2001-2017 Aloha Insurance Services, Inc. Kona HI All rights reserved.
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