Insurance Insurance Client Information Name: Phone Number: Email Address: Property Address: Type of Property: Single Family Home (SFH)TownhomeCondoMulti-Unit (Duplex/Triplex/4-Plex) If multi-unit, how many units? Is this a Primary Residence, Investment Property, or Second Home? Primary ResidenceInvestment PropertySecond Home Do you currently have insurance? YesNo If yes, please provide the following: Current Annual Premium: Name of Insurer: Please provide a copy of your current insurance declaration page (click the button below to upload document) Upload Declaration Page: 4 Point Details [Roof, Electrical, Plumbing, HVAC] Roof Roof Age (years): Type of Roof Covering: Asphalt ShingleTileMetalOther If 'Other', specify: Is the roof in good condition? YesNo If no, explain: HVAC System HVAC System Age (years): Is the HVAC system in good working order? YesNo If no, explain: Plumbing System Plumbing System Age (years): Is there any indication of leaks? YesNo If yes, explain: Electrical System Electrical System Age (years): Is there any indication of hazards? YesNo If yes, explain: Wind Mitigation Details Do you have hurricane shutters? YesNo If yes, what type? Are shutters installed on all windows? YesNo Do you have hurricane impact windows? YesNo Do any doors leading to the exterior have glass? YesNo If yes, do they have shutters or impact glass? If no, is the door an impact door? Garage Door Age (years):
