1896 S. 14th Street, Suite 5
Fernandina Beach, FL 32034
904-261-0707
www.morrowig.com
Homeowners Insurance Quote:

Please note that this form is for a REQUEST ONLY. Submitting this form does not bind coverage in any way. If you do not hear from us ina reasonable amount of time, ASSUME WE DID NOT GET THIS REQUEST FOR AN INSURANCE QUOTE, and call our office.

I understand that filling out and submitting this form DOES NOT bind coverage in any way, and the only way coverage can be bound will be when I am informed of a binder or policy is issued by the agent representing me.
UNDER CONSTRUCTION
Contact Information and Preferences


First Name:

Last Name:

Daytime Phone: () ext.

Evening Phone: ()

E-mail:

Address:

City: State:
Zip:

How do you wish to receive your quote?
By Phone:
By E-mail:
By Mail:

Is this a new purchase? If yes, please go to Section 2. Otherwise, please complete both sections.

Section 1:

Current Insurance Company:
Policy Expiration Date:
Policy Expiration Reason:
Current Policy Limits:
Property Purchase Date:

Section 2:

New Purchase / Closing Date: 

Will there be a mortgage: Yes:   No:

Will mortgage be escrowed: Yes: No:

Please list mortgage company clause & number if you have it:


Primary or Secondary residence:  Primary:  Secondary:

Rental Property: Yes:  No:

Living square footage: 

Garage: Yes: No:
If so, how many cars:

Bedrooms:

Bathrooms:

Do you have any additional property: Yes: No:

Year house was built:
Year electric was updated:
Year roof was updated:
Year plumbing was updated:
Year airconditioning was updated:

Type of roof:
Shape of roof:

Number of glass/French doors:

Construction type:
Property type:
How many stories:

Pool: Yes: No:
Pool type:
Pool Screen Enclosure: Yes: No:
Year enclosure installed:

Fireplace: Yes: No:
Skylights: Yes: No:

Do you have a current appraisal: Yes: No:
Current fair market value:

Claims History of past 5 years (dates, amount paid, cause of loss):

Community Name:

Gated community: Yes: No:

*Do you own any recreational vehicles: RVs, boats, ATVs:
Yes: No:

*Do you own collectibles: Fine art, or jewelry: 
Yes: No:

*If so, a separate policy can be quoted to provide this coverage.

Questions / Additional comments:


Submit Request: