Your Name and Contact Information
Home and Insurance Information
Type of Roof (please select one ) AsphaltClay/TileMetalConcreteWood ShingleOther
Construction Type: (please select one ) MasonryFrame
For homes built before 1995, any Wind Mitigation updates? YesNo
Opening Protection such as Storm Shutters or Impact Resistant Windows? YesNo
If yes, please provide opening protection details:
Other home and property features? Please check all that apply: Screened EnclosureFenceCar Port
Have any hurricane claims been made for this home in the past three years? YesNo
