Re-Shop Request

Re-Shop Request

Term Brokers Internal Use Only
Name
Cms://
Tab #:
Renewal Date
Current Carrier
Current Premium
Renewal Premium: $
Has any contact information changed?
Phone Number
Email
example@example.com
Please confirm the occupancy:
Short Term Rental Details:
Number of Months Occupied:
Number of Weeks Rented:
Has there been any updates to the home since we last quoted?
Provide year updated
Have you had any losses or claims to any properties that we do not insure, whether or not paid by insurance in the last 5 years?
Explanation of claim(s):
(If applicable) Has your lender changed?
Still lender billed/ escrowed?
Who is your lender?
Lender Name and Mortgagee Clause:
What other types of insurance may we help you with?
Notes:
Form completed by:
Occupancy
Do you rent your property to others?
Rental Term Length
Do you have unusual exposures on the property?

Other
What security measures do you have for the pool?
What type and breed of animals? Do they have any bite history?
Please describe
Year Built
!
Roof Year
!
Roof Type
HVAC Year
Water Heater Year
Location of Water Heater

Other
Have you had any claims at this property or any other property in the last 5 years?
Describe when, what type, and how much was paid
Current Premium $
Renewal Premium $
Do you currently hold a flood policy?
Do you want a flood quote?
Is there a mortgage on your home that should be listed on your policy?
Please provide the mortgage name. If we do not have this on file, we will reach out to you shortly to get the loan number.
Mortgage Name (if known)
Is there anything else you would like us to know while shopping your policy?
Submitted By

Other
Term Brokers Insurance Services

348 Miracle Strip Pkwy #30A

Fort Walton Beach, FL 32548

Phone: 850-864-2000

Fax: 850-226-8425

www.termbrokersinsurance.com
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