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Homeowners Insurance Quote
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Homeowners Insurance Quote
Florida Homeowners Insurance Quote Request. One form, multiple carriers, best rates and
package options guaranteed.
Step 1 of 3 - Property Details
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Property Details
Property Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Type of Home
*
--- Please Select ---
Single-family home
Townhome or Duplex
Condo
Apartment
Do you rent or own?
*
--- Please Select ---
Rent
Own (Present Address)
Own (New Purchase)
Purchase Date
Date Format: MM slash DD slash YYYY
Purchase Price?
Estimated Closing Date
Date Format: MM slash DD slash YYYY
Is this New Construction?
*
Yes
No
If yes, who is the Builder?
What Model/Floorplan did you purchase?
Usage & Home Detail
Usage
*
--- Please Select ---
Primary
Seasonal
Secondary
Rental
Vacant
Year Built
Number of Occupants (possible discount)
Total Bathrooms
Square Footage Heated/Cooled
Age of HVAC system? (yrs)
Age of roof? (yrs)
What size is the garage?
--- Please Select ---
1 car
2 car
3 car
4 car
5 car
No garage
What year was the home last painted?
Age of water heater? (yrs)
Where is the water heater located? (possible discount)
-- Please Select --
1st Floor
2nd Floor
Garage
Outside of Home
Alarm System (possible discount)
--- Please Select ---
None
Local Only
Active Burglar Monitoring
Active Burglar & Fire Monitoring
Check all that apply to the home.
Secured community
Screened enclosure (with roof made of screen material)
Swimming pool
Diving board
Pool slide
Tree house
Trampoline
Skate board ramp
Other liability concern
Type of security (possible discount)
--- Please Select ---
Single entry
Gated
24hr. security
24hr. security and gate
If other, please explain:
Underwriting Information
Answering "yes" to any of these questions does not automatically disqualify you from coverage, but helps us get you the best rates available for your situation.
Any claims made in the last 5 years?
*
No
Yes
What was done to fix the damage?
Date of claim(s)
Amount paid by insurance
Cause of loss
Is there any existing damage to the home?
No
Yes
If yes, please explain:
Has any applicant ever filed a sinkhole loss claim?
No
Yes
If yes, please explain:
Any sinkhole loss or settling loss at this home (ever)?
No
Yes
If yes, please explain:
Any business conducted at this home requiring client foot traffic?
No
Yes
If yes, please explain:
Has this home had any previous water damage?
No
Yes
If yes, please explain:
Has any applicant had a bankruptcy, foreclosure or repossession in the past 5 years?
No
Yes
If yes, please explain:
Has any insurance applicant been non-renewed, canceled or declined due to insurance misrepresentation or fraud?
No
Yes
If yes, please explain:
Has any applicant been convicted of a felony or crime of arson?
No
Yes
If yes, please explain:
Do you own any 4 wheel ATV-type vehicles (go-carts, golf carts, etc)?
No
Yes
If yes, please provide details:
Will any animals reside on the premises?
No
Yes
If yes, please specify type of animal(s) and breed(s)?
List any prior claims, bites or police/military training.
If you've had a four point or wind mitigation inspection completed, please upload a copy below.
Max file size 2MB / Allowed file types: PDF, JPG, PNG, DOC
Accepted file types: pdf, jpg, png, doc.
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Name
*
First
Middle Initial
Last
Email Address
*
Best Contact Number
*
Phone Number Type
*
--- Please Select ---
Mobile
Home
Work
Current or Most Recent Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Your Date of Birth
*
MM
DD
YYYY
What is your highest degree of education?
--- Please Select ---
High School
Some college
Two year degree (AA)
Four year degree (BA or BS)
Graduate school / Masters
Doctorate
Law Degree
Marital Status
--- Please Select ---
Married
Single
Divorced
Widowed
Spouse's Name
*
First
Middle Initial
Last
Spouse's Date of Birth
*
MM
DD
YYYY
Spouse's highest degree of education?
--- Please Select ---
High School
Some college
Two year degree (AA)
Four year degree (BA or BS)
Graduate school / Masters
Doctorate
Law Degree
How Did You First Hear About Us?
--- Please Select ---
Realtor
Mortgage broker
Google search term
Referral from friend, co-worker, neighbor, relative
Angies List
Postcard
Email campaign
Tower Hill Insurance Group Quote Request
Facebook Ad
Better Business Bureau
I'm a current client
Yelp
Elementary School Sponsorhip
Insurance Company Website
Community Advertisting
Other
Referral Source Name:
Please specify:
Do you have a preferred agent you would like to work on your quote?
No Preference
Gina McNairy
Ileana Zumbado
Josh Butts
Karen Aragon
Kim Glowiak
Pammie Bussey
Is there any other information you would like the agent to consider when quoting for you? Any questions or specific items you would like to see on your quote?
What is your mindset with your insurance coverage?
*
Please select which description most accurately describes what you are looking for.
I want the absolute least expensive policy and am not concerned with endorsements and optional coverage. Make it cheap and be acceptable to my lender/mortgage company and that is all I want.
I want a great value. I would like a good carrier and coverage for a competitive rate in the market. I want the more important endorsements like replacement cost contents, water back up, law and ordinance and screened enclosure coverage if needed.
I want an AM Best A-Rated carrier and will pay a fair price to have the strongest company with robust endorsements. Rate is a consideration but not at the loss of carrier and coverage quality.
Other
Additional Comments / Clarification
I agree with below statement
*
Some insurance companies provide discounts to those with good credit by running an insurance score. By submitting this form, you authorize us to run your insurance score with the carrier and provide this discount should you qualify. Running an insurance score does not count as a "hard inquiry" against your credit score. By submitting this form, you agree to allow us to make sure you get every available discount, including a financial responsibility credit if you qualify. We look forward to working with you.
Yes, I agree
Would you like to save even more with an Auto Bundle? Only one more step.
Yes please!
Not today.
How many other licensed drivers in the home?
--- Please Select ---
None
1
2
3
4
Name of Additional Driver #1
First
Middle Initial
Last
Driver #1 Date of Birth
MM
DD
YYYY
Do any of the following apply to this driver? (possible discount)
Good Student Discount (3.0 GPA or higher)
Drivers Education
Away at school without a car (more than 100 miles away)
Insured with another company
Name of Additional Driver #2
First
Middle Initial
Last
Driver #2 Date of Birth
MM
DD
YYYY
Do any of the following apply to this driver? possible discount)
Good Student Discount (3.0 GPA or higher)
Drivers Education
Away at school without a car (more than 100 miles away)
Insured with another company
Name of Additional Driver #3
First
Middle Initial
Last
Driver #3 Date of Birth
MM
DD
YYYY
Do any of the following apply to this driver? (possible discount)
Good Student Discount (3.0 GPA or higher)
Drivers Education
Away at school without a car (more than 100 miles away)
Insured with another company
Name of Additional Driver #4
First
Middle Initial
Last
Driver #4 Date of Birth
MM
DD
YYYY
Do any of the following apply to this driver? (possible discount)
Good Student Discount (3.0 GPA or higher)
Drivers Education
Away at school without a car (more than 100 miles away)
Insured with another company
What auto carrier are you currently insured with?
How long have you been with this carrier? (possible discount)
--- Please Select ---
Less than 6 months
Less than 1 year
12-18 months
2 years
3 years
4 years
5+ years
Do you know your Bodily Injury Limits?
--- Please Select ---
I don't know
25/50
50/100
100/300
250/500
500 CSL
Do you carry uninsured motorist coverage?
Yes
No
Unsure
Has any driver in the household had any tickets, accidents or claims in the past 3 years?
No
Yes
If yes, please explain:
Describe each incident including Date, Driver, Type of incident (at fault, non at fault, speeding, other) and any other relevant details.
Name
This field is for validation purposes and should be left unchanged.
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