Partner – M&P Commercial Intake

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Name of Agent Submitting Quote

First

Last

Agent Phone Number

Agent Email Address

Which Agency should this be written under?

Macdonald & Pangione Ins. Agency Inc
R C Briggs Insurance Agency
Barry J Kittredge Insurance Agency

Client Information

What's your reason for seeking flood insurance?"

When do you need the policy to start?

Named Insured (Company)

If a legal entity owns the building, please provide its name. If the building is owned personally, enter your first and last name. If you do not have a legal entity set up, you may skip this question.

What type of entity owns the property?

Primary Contact

First

Last

Secondary Contact

First

Last

Your Phone Number

Your Email Address

Now, let's get some specific details about the property you want to insure.

Property Address for Coverage

Address Line 1

City

State

Zip Code

Please Enter Your Local County Name

Is your mailing address the same as this property?

Is your property currently under construction or planned to be built?

What type of property are you looking to insure?

How is the building primarily used?

What year was the building constructed?

How much coverage do you need for the building itself?

How much coverage do you want for your personal belongings inside (like furniture, electronics, clothing)?

How much loss of business income coverage do you want?

Deductible

$5,000
$10,000
$25,000
$50,000

Do you need insurance for other structures on your property?

Has the property experienced flood damage?

What type of foundation does your building have?

How many floors does the building have?

How many floors above ground does the building have? (Do not include the basement.)

What is the total square footage of the structure?

What material is the building's frame constructed from?

What type of garage does the property have?

Does your property have any rooms with floor-to-ceiling wood paneling?

What flood zone is your property located in?

If you’re unsure about your flood zone, simply select Zone AE, and your flood nerd will verify your correct flood zone for you. This ensures you get accurate coverage without the guesswork.

Additional Information

Please share any other details or notes about your property that you think are important for your insurance coverage.

File Upload Section

Click or drag files to this area to upload. You can upload up to 10 files.

Please upload any relevant documents or images here. This can include photographs of the property, architectural drawings, an Elevation Certificate, documentation of your flood zone, lender correspondence, prior insurance policies, or any other pertinent information.

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Yes I agree.

Save and Resume Later

Partner – M&P Commercial Intake

Client Information

Now, let's get some specific details about the property you want to insure.

You've Choose 'Mobile Home/Manufactured Home': Review the descriptions to confirm your choice.

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