Flood Insurance Quote

We would like to provide you with a free, no-obligation flood insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

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:

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:	Dwelling:	Contents:
Dwelling 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 Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

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Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.

Community Insurance Group

139 Harristown Road, Suite 202
Glen Rock, New Jersey 07452

Phone:
Toll Free:
Fax:
Fax (NJ only):

201-444-4426
855-344-4426
201-444-0731
800-440-2267