Florida Homeowner Insurance Quote

Personal Information

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

Name ✶

Date of birth ✶

Street address ✶

City ✶

State ✶

ZIP ✶

Phone ✶

Email ✶

Preferred contact method(s) ✶

Call

SSN

Bankruptcy or foreclosure in last 5 years? ✶

Yes

I give permission to run an insurance score ✶

Co-Owner

Name

Relationship

Date of Birth

Home Information

Purchase Information

Closing date

Property Location

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

General

Occupancy ✶

Type ✶

Solar Panels

Does the home have solar panels? ✶

Yes

Panel location ✶

Roof

Ground

# of panels ✶

Interior

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

Inspections & Appraisals

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 homeowners insurance claim in the past 5 years?

Yes

Desired Insurance Coverage

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

Flood

Jewelry/Personal Articles

Do you have an appraisal or bill of sale dated within 3 years?

Yes

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

Personal Information

Home Information

Insurance Coverage Information