Full Name:          
Address to be Insured:
City:
Florida
Zip Code:
Email Address: (Required) 
Home Phone:   Work Phone:   Ext.
How to Contact You:       Cell Phone:
Date of Birth:              (mm/dd/yyyy)

Do you currently have Florida Flood Insurance?
Do you currently have FL Homeowners Insurance?
Coverage requested for?
Usage Type:
Years Lived at Address to be Insured:  

Florida Homeowners Insurance Coverages & Limits of Liability:

Dwelling ($ value):
Additional Structures ($ value):
Personal Property ($ value):    

Personal Liability (each occurence):
Medical Payments (each person):   
Other Perils Deductible:
Windstorm Deductible:

Policy Endorsements:

Replacement Cost, Dwelling: Yes No
Replacement Cost, Contents: Yes No

Florida Homeowners Insurance - Dwelling Information:

Building Structure:
Year Dwelling Built:     Dwelling Square Feet:
Smoke Detectors?             Deadbolt Locks?    
Central Burglar Alarm?      Central Fire Alarm?
Sprinklered All Rooms?
Primary Heat Type:
Do you have a Wood Stove? If yes, is it on a separate flue?

Fireplace: 
Full Baths:     Half Baths:   
Garage:         Garage Size:
Basement:

Type of Wiring:         
Wiring Renovation:         Wiring Renovation Year:   
Plumbing Renovation:     Plumbing Renovation Year:
Heating Renovation:       Heating Renovation Year:  
Roofing Renovation:       Roofing Renovation Year:  
Roof Type:     Roof Age (years):
Exterior Paint Renovation:     Exterior Paint Renovation Year:

Dwelling Distance from Fire Department:  miles
Dwelling Occupied By:
Swimming Pool:              Diving Board:  
Pool Screened:               Approved Fence:  

Loss History:

Did you have any losses, whether or not paid by insurance, during
the last 3 years, at this dwelling location or any other location?
If the answer to the previous question was "Yes", please explain below.

Date                            Type                          Description of Loss           Loss Amount
      

Additional Information or Comments



Click on the "Submit Quote Information" button below to send
your Florida Homeowners Insurance quote request.**


**Information received from this Florida Homeowners Insurance quote request
form sent to FCI Auto Tag & Insurance Agency will be for our use only and will
not be sold given to or distributed to any other parties. A quote will be based on
the homeowners insurance policy information provided and does not guarantee
acceptance of the risk by us. The precise coverage afforded is subject to
meeting underwriting guidelines, and the terms, conditions and exclusions of
the policy as issued. By submitting this request you acknowledge that this is
neither an offer to insure nor a guarantee of insurance. Completion of this
form does not entitle you to a Florida Homeowners Insurance policy. We are
licensed in Florida will not provide homeowners quotes for other states.


We can provide affordable Florida Homeowners Insurance
coverage throughout the Broward County area!
FCI Auto Tag &
Insurance of Davie,
FL offers affordable
and experienced
personal insurance
coverage services
throughout Florida.
Contact us about
Florida Auto,
Renters, Homeowner,
Boat, Motorcycle,
RV, and Flood
Insurance at (954)
434-6515.
In addition to
Florida Homeowner
Insurance quotes,
we also offer
affordable Auto
Insurance policy
quotes.
We are a Davie, FL insurance agency offering affordable Florida homeowners
insurance quotes to residents of the following cities and counties: Coral
Springs, Fort Lauderdale, Parkland, Coconut Creek, Margate, North
Lauderdale, Lighthouse Point, Hillsboro Beach, Deerfield Beach, Boca
Raton, The Hamptons, Highland Beach, Weston, Plantation, Playland Isles,
Melrose Park, Lauderhill, Sunrise, Tamarac, Wilton Manors, Oakland Park,
Lauderdale Lakes, Sea Ranch Lakes, Villages of Oriole, Pompano Beach,
Lauderdale-by-the-Sea, Boca West, Delray Beach, Boca Pointe, Boynton
Beach, Lantana, Rainbow Lakes, Atlantis, Lake Worth, Miami, South Palm
Beach, Palm Springs, Greenacres, Wellington, Haverhill, Palm Beach,
Golden Lakes, Riviera Beach, Glen Ridge, West Palm Beach, Lake Park,
Royal Palm Beach, Jupiter, Juno Beach, North Palm Beach, Loxahatchee,
Belle Glade, Palm Beach Shores, South Miami, Cutler Ridge, Princeton,
Perrine, Naranja, Homestead, Florida City, Leisure City, Richmond Heights,
Pinecrest, Howard, Coral Way Village, Westchester, Westwood Lakes,
Brownsville, Sweetwater, Key Biscayne, North Bay Village, Miami Beach,
Miami Springs, Virginia Gardens, Hialeah, El Portal, Miami Shores, Medley,
Indian Creek, Surfside, Bal Harbour, North Miami, Biscayne Park, Pinewood
Park, Opa Locka, Bunche Park, Hialeah Gardens, Palm Springs North,
Carol City, Norland, Ojus, Miami Lakes, Biscayne Gardens, Hallandale,
Sunny Isles Beach, Golden Beach, Aventura, Uleta, Miramar, Pembroke
Pines, North Miami Beach, Hallandale Beach, Ives Estates, Pembroke Park,
Coral Gables, Kendall, Dania Beach, Cooper City, West Miami, Hollywood,
Broward County, Palm Beach County, and Miami-Dade County, FL. We can
also offer affordable Florida homeowners insurance quotes throughout the
Sunshine state, including in Orlando, Tampa, St. Petersburg, Sarasota,
Tallahassee, Gainesville, and Jacksonville, FL.

Florida
Homeowners
Insurance Quote
Applicant Information
Your Broward County
Florida Homeowners
Insurance Quote Source
F.C.I. Auto Tag
& Insurance Agency, Inc.
8276 Griffin Road
Davie, Florida 33328
Broward County FL
(954) 434-6515
Fax: (954) 434-6524

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