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Enter Previous Address (under 2 years) Mailing Address
Previous Address or Mailing Address
Street Address
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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Coverage & Discount Section
Construction Type:
*
Frame - Wood-frame construction
Joisted masonry (masonry walls with wood joisted roof/floors)
Brick Veneer (wood frame with brick exterior)
Non-Combustible – Made entirely of non-combustible materials (e.g., metal walls/roof)
Masonry Non-Combustible – Masonry exterior walls with non-combustible interior support
Fire Resistive Reinforced concrete or protected steel — fire resistance rating of at least 2 hours
Roof Type:
*
Asphalt/Shingle (most common)
Tile
Wood Shingle
Slate
Metal
Distance to Saltwater:
*
<1000 Feet
10+ Miles
1,000 ft-1 Mile
1 Mile - 10 Miles
Any Losses in the Past 5 Years?
*
Yes
No
If you have had a claim/losses:
Roof
Theft
Water
Property ownership
*
Renewal
New Purchase
Pending Offer
Do you have a Mortgage?
*
Yes
No
Deductible Buy Back Retention?
*
$2,500
$5,000
$10,000
$25,000
$50,000
Wind/Hail Deductible On Your Current Policy
*
1%
2%
3%
5%
Other
Property Information (Found on your Insurance Policy)
Property Carrier
*
Coverage A
Property Policy Number:
Coverage A
Overlying Policy Coverage in Place (Found On Your Declaration Sheet)
*
Coverage A
Overlying Policy Coverage in Place
Coverage B
Overlying Policy Coverage in Place
Coverage C
Overlying Policy Coverage in Place
Coverage D
Finalize and Submit...
When do you want your policy to start?
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Confirmation Email
How did you hear about us?
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Google
Google Maps
Yahoo
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Referral
Ines Belman
John Shawareb
How would you like us to contact you?
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Call
Email
Text
TEXT (We will send an Opt-in text) (405) 369-4641
Phone (We will not call you unless you have requested a call)
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Please enter a valid phone number.
TEXT (405) 369-4641 (We can send an Opt-in text) From OKC Insurance Brokers
*
Yes
No
NOTES - Please explain any losses in the previous 5 Years.
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Wind Deductible Buy Down
Oklahoma & North Texas
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