Florida Homeowner Insurance Quote

Personal Information

I understand that Members Insurance Center is unable to assist with mobile home coverage at this time. ✶

First name ✶

Last name ✶

Street address ✶

City ✶

State ✶

ZIP ✶

Phone ✶

Email ✶

Preferred contact method(s) ✶

Call

Date of birth ✶

Occupation ✶

Gender ✶

Male

Female

SSN ✶

Bankruptcy or foreclosure in last 5 years? ✶

Yes

I give permission to run an insurance score ✶

Co-Owner

Name

Relationship

Date of Birth

Gender

Male

Female

Home Information

Is this your primary residence? ✶

Yes

Is this a new purchase? ✶

Yes

Closing date

Is the property a foreclosure, short sale or bank owned property?

Yes

Property Address

Where is the property located? ✶

At the address above

At a different address

Street address ✶

City ✶

State ✶

ZIP ✶

Located in a Gated or Secured Community? ✶

Yes

Distance to fire hydrant ✶

Distance to fire station ✶

miles

General

Year built ✶

Type ✶

Stories ✶

Construction ✶

Foundation ✶

Living space ✶

sq ft

Utilities

Age of electric ✶

yrs

Age of plumbing ✶

yrs

Age of heating ✶

yrs

Age of water heater ✶

yrs

Water heater location ✶

Central air? ✶

Yes

Does the home have solar panels? ✶

Yes

Panel location ✶

Roof

Ground

Were the panels installed at the time the home was built? ✶

Yes

Number of panels ✶

Manufacturer ✶

Interior

Full baths ✶

Half baths ✶

Fireplaces ✶

Type of flooring ✶

Finished basement? ✶

Yes

Finished bsmt size ✶

sq ft

Exterior

Roof type ✶

Year Roof Replaced ✶

Garage type ✶

Garage size ✶

Deck? ✶

Yes

Deck size

sq ft

Screened porch? ✶

Yes

Screened porch size

sq ft

Monitored Security System? ✶

Yes

Security System Purpose

Fire

Theft

Outdoor Pool? ✶

Yes

Pool fenced? ✶

Yes

Diving board or slide? ✶

Yes

Hazards on premises? ✶

Trampoline

Skate Ramp

ATV

None of these

I have a pet ✶

Yes

Type of pet (including breed if it is a dog)

In-home business? ✶

Yes

Type of business?

Insurance Coverage Information

Prior coverage cancelled or non-renewed in the last 3 years? ✶

Yes

Inspections

Do you have a Wind Mitigation Inspection and/or a 4-Point Inspection? ✶

Yes

Upload inspection doc(s)

Or email to membersinsurance [at] floridamic [dot] org

Claims History

Have you made a claim in the past 5 years?

Yes

Date of loss

Total payout on loss

Description of loss

Current Insurance

I currently have a home insurance policy ✶

Yes

Insurance company

Current Premium

Policy expiration

Coverage amount

Current policy declarations page (PDF)

This is optional but can help us with the quoting process

Desired Insurance Coverage

Are you interested in learning more about any of these coverage options?

Flood

Jewelry/Personal Articles

Comments or questions

I understand that coverage cannot be bound or altered until the information has been confirmed by one of our representatives by phone or email. ✶

Subject

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Secure form

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HOMEOWNER INSURANCE QUOTE

Personal Information

Home Information

Insurance Coverage Information