Homeowner Insurance Quote - Bogert Insurance Agency of Florida

Bogert Insurance Agency, Inc.
Full Service Insurance Agency - All Lines
"Serving ALL of Florida" 877-446-6335 877-316-7800 (FAX)

E-mail:insuranceflorida@aol.com
Our agency is licensed to quote and write insurance policies only in Florida. To find agents offering these coverage in all of the other states, please click the IQ.net logo.

Fill out this form and submit it to our agency to receive an accurate Homeowner Insurance Quote

Name: (required)

E-Mail Address: (required)

Street:

City: (required)

County:

State:(required) Zip: (required)

Day Phone:

Evening Phone:

FAX:

Social Security #

In order to provide a PREFERRED policy quote some of the companies that we represent may require a credit history. For Preferred quotes, Social Security numbers are required. You do not have to provide social security numbers at this time but we can't guarantee that we can provide the best price available until after we speak with you and secure this credit information.

Check this box to grant our agency permission to secure your credit history, for insurance purposes only, under the Fair Credit Reporting Act. Your name

Current Homeowner Coverages

Dwelling Amount (required)

Personal Property (contents), Outbuilding Coverage, Additional Living Expenses are calculated from the dwelling amount.

Property Coverage Deductible

Comprehensive Liability Amount

Medical Payments

Guaranteed Replacement Cost Coverage

Water Backup Coverage

Earthquake Coverage

Tell us about your home:

Construction

Type Of Home

Number of Stories

Ground floor square footage

Total basement area (sq ftt)

Condo Owners or Renters Only - Personal Property Amt

Year home built

Distance to nearest fire hydrant

Distance to nearest fire station

Inside or Outside of City?

If outside. How many miles?

Type of Alarm

Sprinklers?

Any business conducted on premises?
Type of business

Any animals?

Breed & Weight

Any losses past 3years? Please describe what type of loss and dollar amount of loss

The following is optional information, but by providing it we are able to give you a more accurate quotation.

Shape of house (# of corners)

3 Wall Addition? (square feet)

Percent of basement finished

Attached Garage

Number of Bathrooms

Family Room

Sun Room

Den

Number of Fireplaces

Separate Dinning Room

Any hardwood Floors

Central Air Conditioning

Decks ( total square feet)

Porches (total square feet)

Large Laundry Room

Large foyer

Central Vac

Video entry system

Sauna

Hot tub

Jaquzzi bath

Dishwasher

Trash Compactor

Range hood

Garbage disposal

Any aditional information that you might feel is important in quoting you home insurance

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Page Created 11-12-99

Latest Revision

Name: (required)
E-Mail Address: (required)
Street:
City: (required)
County:
State:(required)	Zip: (required)
Day Phone:
Evening Phone:
FAX:

Social Security #
In order to provide a PREFERRED policy quote some of the companies that we represent may require a credit history. For Preferred quotes, Social Security numbers are required. You do not have to provide social security numbers at this time but we can't guarantee that we can provide the best price available until after we speak with you and secure this credit information.
Check this box to grant our agency permission to secure your credit history, for insurance purposes only, under the Fair Credit Reporting Act. Your name

Dwelling Amount (required)
Personal Property (contents), Outbuilding Coverage, Additional Living Expenses are calculated from the dwelling amount.
Property Coverage Deductible
Comprehensive Liability Amount
Medical Payments
Guaranteed Replacement Cost Coverage
Water Backup Coverage
Earthquake Coverage

Construction
Type Of Home
Number of Stories
Ground floor square footage
Total basement area (sq ftt)
Condo Owners or Renters Only - Personal Property Amt
Year home built
Distance to nearest fire hydrant
Distance to nearest fire station
Inside or Outside of City?
If outside. How many miles?
Type of Alarm
Sprinklers?
Any business conducted on premises?		Type of business
Any animals?		Breed & Weight
Any losses past 3years? Please describe what type of loss and dollar amount of loss

Shape of house (# of corners)
3 Wall Addition? (square feet)
Percent of basement finished
Attached Garage
Number of Bathrooms
Family Room
Sun Room
Den
Number of Fireplaces
Separate Dinning Room
Any hardwood Floors
Central Air Conditioning
Decks ( total square feet)
Porches (total square feet)
Large Laundry Room
Large foyer
Central Vac
Video entry system
Sauna
Hot tub
Jaquzzi bath
Dishwasher
Trash Compactor
Range hood
Garbage disposal
Any aditional information that you might feel is important in quoting you home insurance

	Fill out this form and submit it to our agency to receive an accurate Homeowner Insurance Quote