landecheinsurance

Home, Landlord and Flood Policy

TWFG Landeche Insurance 504-228-7184
Insured Name

First NameLast Name
Date of Birth

MonthDayYear
Date
E-mail
Co -Applicant

First NameLast Name
Date of Birth

MonthDayYear
Date
Email
example@example.com
Applicant's Marital Status
Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you lived at a different primary address in the last 2 years?
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
By submitting your mobile number, you agree to receive periodic text messages from us. Standard messaging rates may apply.
What type of Policy
A flood quote might require an elevation certificate. Please upload
Flood elevation Certificate. Please attach if available.

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Do you have currently have homeowners Insurance?
Is this a new Purchase?
What is the reason you did not have insurance?
What is the date you last had home insurance?

MonthDayYear
Date
What is your current dwelling amount?
Coverage A
Current Insurance Company
Annual Premium
Date you would like coverage effective

MonthDayYear
Date
Type of Home
Number claims in past 6 years
Please give date of claim, amount of claim and cause of claim.
Does the home have any pre-existing damage?
Basic Information
Year Built
Square Feet
Number of Stories
Number of Baths?
Number of Half Baths?
Home Color
This makes it easy to find on google maps.
Plumbing Update year?
If never put year built
Primary Heating Type?
Other ?
Primary Heating Type
Heating year ?
If never put year built
Water Heater year?
Installed or updated
Do you have a tankless water heater?
Wiring update year?
If never put year built
Roof Replaced year?
If never put year built
Occupied by

Exterior Information
Construction
Foundation
Roof Material
Do you have a Fortified Roof?
Type of Roof

Other Information
Do you have Hurricane Shutters
Do you have a fire alarm- central reporting
Do you have a burglar alarm - central reporting
Do you have a fire place?
What Type?
Electrical
Central Air and Heat?
Do you have a Home Generator Permanently Connected?
Garage or Carport
Attached
How many Cars?
Do you have a Patio Cover?
Attached or Detached
Do you have a swimming pool?
Type of pool?
Do you have a fenced in yard?
Do you have a slide or diving board?
Trampolines
Do you have any dogs?
How many?
What breed?
Do you have an active Flood policy?
Some Carries will offer a discount for an active flood policy
Flood Dec Page

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We will need a copy of the dec page for a discount. Cancelof
Do you need another type of insurance quote?
Please Specify
How did you hear about us?
Friend,Google, Facebook, Bing and etc.
Do you have an insurance you would like to request?
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Home, Landlord and Flood Policy

Basic Information

Exterior Information

Other Information