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Your contact information Your contact information Name Phone number (123-456-7890) Email Street Address City State Zip Code Occupancy type Occupancy type Single family Two- to four-family Other residential Non-residential Condo unit Number of floors Number of floors One Two Three or more Is there a basement? Is there a basement? Yes No Date of construction (e.g., 1979) Date of construction (e.g., 1979) Desired Building Property limit Desired Building Property limit Please select one ... $25,000 $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 Unknown Desired Personal Property limit Desired Personal Property limit Please select one ... $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 Unknown Do you have an Elevation Certificate? Do you have an Elevation Certificate? Yes           If Yes, please fax to 954-837-4357 or email to floodquotes@1ststreetagency.com No What's the Coverage A (dwelling) limit on your homeowners policy? What's the Coverage A (dwelling) limit on your homeowners policy? Please select one ... Under $100,000 $100,001 to $150,000 $150,001 to $200,000 $200,001 to $250,000 $250,001 to $300,000 $300,001 to $400,000 $400,001 to $500,000 Over $500,000 Unknown If you currently have flood insurance, what's the expiration date (mm/dd/yyyy)? If you currently have flood insurance, what's the expiration date (mm/dd/yyyy)?