| | |
|
Your Name:
|
|
|
Property Address:
|
|
|
City:
|
|
|
Your "County" is?
|
|
|
State:
|
MUST be Texas!
|
|
Zip/Postal:
|
|
|
E-Mail (REQUIRED):
|
|
|
E-Mail again for accuracy:
|
|
|
Phone:
|
|
|
Fax (optional):
|
|
| |
| | |
|
Dwelling Information |
| | |
Do you have a TWIA Windstorm
Policy Presently?
|
NO
YES
|
| | |
|
Year Home Built:
|
|
|
Home Square footage: |
|
| | |
|
Select Policy Type: |
Windstorm/Homeowners
Renters Condo
Mobilehome
|
| | |
|
Number of units: |
1 family
Duplex
|
| | |
|
Type foundation: |
Slab
Crawlspace over
slab
Pier & Post
Other
(list in remarks)
|
| | |
|
Type Construction: |
Frame
Brick/Veneer
Stone
Other
(list in remarks)
|
| | |
|
Type Roof: |
Shingle
Wood Shake
Tar/Gravel
Spanish Tile
Metal
Other
|
| | |
|
Number of stories: |
One
1.5
Two
Three
|
| | |
|
Currently Insured? |
Yes
No
|
|
Name of Carrier & how long insured? |
|
| | |
|
Prior Claims? |
Yes
No
|
|
Describe claims in detail: |
|
| |
Primary Policyholder's Birthdate:
(Some companies
have discounts for certain age groups.)
|
|
