Freedom insurance In Orlando, Fl

Any poly-butylene pipes in the home?:

Loss History: (List any losses within the last 5 years, type of loss, and amount):

Questions and Concerns about home owner's insurance? Please list all of your questions and concerns, and an insurance professional will get in contact with you.

How did you hear about Freedom Insurance? *

Personal Liability Coverage:

Deductible:

Hurricane Deductible:

Medical Payments:

If your home is over 20 years old answer the remianing questions....Are pipes copper?

Electrical Updated:

Year of Electrical Update:

Heating Updated:

Year of Heating Update:

Roof Updated:

Year of Roof Update:

Plumbing Updated:

Amount of Coverage on Personal Property:

Central Fire Alarm (must be monitored):

Central Burglar Alarm (must be monitored):

Primary Heat Source:

Home Construction Type:

Property Type:

Year Property was Built:

Do you currently have homeowner's insurance?

Daytime Phone Number:

Mailing Address If different than property address:

Evening Phone Number:

Email: *

Check here to receive email updates

State: *

Zip Code: *

Owner #1, First & Last Name: *

Owner #2, First & Last Name:

Street Address of Property: *

City: *

Age of Water Heater:

Any knob-tube wires in the house?

Does the electrical system use fuses?

Does home have 100 AMP or greater service?

Do you currently have or have any plans for portable heating?

Swimming pool or similar structure?

If yes, is the pool screened or fenced?

If yes, what is the height of the fence in feet?

If yes, does the pool having a diving board or slide?

ChooseIs there a trampoline on property?:

Is there a skateboard ramp on property?

Do you have or intend to have any dogs on property?

If yes, what is the breed of the dog(s)? If a mix, what kind?

Year of Plumbing Update:

Distance to Fire Hydrant (ft.):

Inside City Limits:

Amount of Coverage on Dwelling:

Number of Families:

Number of Stories:

If so, when does your current policy expire?

Is this a new home purchase?

Washing machine hoses replaced in the last 5 years?

FREEDOM INSURANCE

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