First Florida Insurance of Merrit Island

Homeowners Insurance Quote

Thank you for the opportunity to allow us to quote your homeowners insurance. Please answer every single question on this form so that we can serve you accurately. We will be in touch shortly with some options. Call direct to speak with an agent (321) 205-1741.

Date

Insured's Name

Spouse's Name

Email Address

Property Address

Zipcode

Work Phone

Home Phone

Cell Phone

Prior Carrier

Expiration Date

New Purchase

If No, are you being cancelled or non-renewed by your current carrier?

If yes, please explain why the current carrier is dropping or not renewing the policy

If older than 1998, what is the age of the roof?

Year Built

Occupancy

If over 30 years old, does the home have either fuses or knob and tube wiring?

Desired Coverage Amount

Is the Foundation Open or Crawl Space?

If yes, how is the foundation enclosed?

Pool

Is the pool within a cage enclosure?

Pool Slide

Diving Board

If there is a pool, is it fenced with a locking gate?

Central Heat and Air

Alarm System

Trampoline

Pets

Bankruptcy, foreclosure or repo in the last five years

Insured's Date of Birth

Spouse's Date of Birth

Is the insured a smoker?

Is your spouse a smoker?

May we quote your auto insurance along with your Homeowner's quote? We offer package policy discounts up to 20 percent for those that qualify.

Thank you for the opportunity to quote your business! Is there anything else you would like us to know?

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