Parsons & Associates. Inc. -- Insurance & Risk Management

Flood Insurance
Flood Insurance Proposal Form
For the fastest and most accurate flood insurance proposal, please provide as much information possible in the form below. This information will be kept confidential and will be used for proposal purposes ONLY!


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We only accept inquiries for insurance written in New York State

General Information
Name:
Address:
City:   State:   Zip:
Day Phone:   Night Phone:
Best Time To Call:   AM   PM
Email Address:
Property Address (if different):
City:   State:   Zip:
Social Security #:   Date of Birth:


Current Flood Insurance Information
Company Name (not agency):
Policy Expiration Date:   Policy Type: Primary Secondary


Home Information
How Long At Present Address:     Year Home Was Built:
Lender Name:    
Lender Address:    
Sq. Footage (excluding garage
and basement):
sq. ft.         # of Claims In Last 3 Years:


Structure Information
Type
Construction
Roof
Foundation
Garage
Age of roof: yrs.


Coverage Desired
Deductible's:
Building:
Contents:
Building Coverage:
Select preset
limit below:
Or enter your own limit
(can't exceed $250,000):
$
Contents Coverage 
(Personal Property): 
Select preset
limit below:
Or enter your own limit
(can't exceed $85,000):
$
Your Personal Property is Located:    Basement Only
  Basement and Above
  Lowest Floor only above ground level (basement not incl)
  Lowest floor above ground level and above

 
Miscellaneous Information
Do you qualify as a small business risk?: Yes     No
Is building your principle residence?: Yes     No
Is the building in the course of construction?: Yes     No
Is insured property owned by state government?: Yes     No
Is your building elevated?: Yes     No
Is your building in a special flood hazard area? (if not certain leave blank): Yes     No
FEMA (flood rate zone) (if not certain leave blank):

 
Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough space, please enter them here.


Please click on the "Submit Proposal" button to send your proposal request.
One of our representatives will respond to your submission as soon as possible.

   


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