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First Insurance Agency of the Hill Country

Quotes
Customer Service

Homeowners Flood Insurance Quote Request

Homeowners Flood Insurance Quote Request

For your protection and security, the information you provide is sent to us via a secured server. Please fill out this form as completely as possible to ensure an accurate request.

Complete the following information if you would like to obtain an Artisan Contractor Insurance quote. Please understand this is not an application. An application will be sent to you if coverage is desired.
All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.
Personal Information
Select Your State
Please Note: We only write insurance for these states.
What is your address?
Street Address Address Line 2 City State ZIP Code
What is your name?*
First Last
What is your telephone number?*
Email Address*
What is your email address?
Fax
What is your fax number?
What is your business name?
Building & Property Information
What is the property address?
Street Address Address Line 2 City State ZIP Code
What is the occupancy type?
What is the building type?
What year was it built?
Please enter a number greater than or equal to 1300.
What is the flood map zone number?
What is the community flood number?
How many bedrooms?
Please enter a number greater than or equal to 0.
How many bathrooms?
Please enter a number greater than or equal to 0.
How many fireplaces?
Please enter a number greater than or equal to 0.
What date was it purchased?
MM slash DD slash YYYY
Does the residence have a basement?
What is the total square footage of the building?
Please enter a number greater than or equal to 0.
How many units are in the building?
Please enter a number greater than or equal to 0.
What is the garage description?
Stories
How many stories is it?
Please enter a number from 0 to 99.
What is the construction type?
What is the foundation type?
What is the nature of sub-soil?
What is the topography?
What type roof covering?
Is the roof updated?
- Yes
- No
If yes, what year?
Year Roof Updated
Please enter a number from 1700 to 3000.
Is there any erosion in the area?
Is there any below ground parking?
- Yes
- No
Is there any soft first story or tuck under parking?
- Yes
- No
What is the distance of fire protection?
Is the business in a brush area?
- Yes
- No
If yes, has the brush been cleared by 250 feet from all around the building?
- Yes
- No
Smoke Detectors
- Yes
- No
Fire Extinguishers
- Yes
- No
Circuit Breakers
- Yes
- No
Is the electrical updated?
How old is the heating/ air conditioning?
What is the energy source?
Has the plumbing been updated?
- Yes
- No
If yes, what year was the plumbing updated?
Please enter a number from 1700 to 3000.
Is the plumbing copper?
Does the building have interior automatic fire sprinklers?
- Yes
- No
Is there a fire alarm?
- Yes
- No
Has the building been retrofitted or bolted?
Claims Information
Were there any losses or claims in the last 5 years?
Losses – Claims
- Yes
- No
What is the date, amount paid and description of each loss or claim?
Coverage Information
What is the current insurance company?
Amount Current Coverage
How much are you paying now?
Building Coverage
What is the building coverage requested?
Other Structures Coverage
What is the other structures coverage requested?
Contents Property Coverage
What is the contents property coverage requested?
Loss of Income Coverage
What is the loss of income requested?
Are there any questions, comments or additional coverage required?
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First Insurance Agency of the Hill Country

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