Knight Insurance
1259 S Pine Island Rd
Plantation, Florida 33324
Phone: 954-382-5244
Info@knightinsuranceoffice.com
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Home Owner, Condo, Dwelling Insurance Quote
Contact Information
First & Last Name:
E-Mail Address:
Street Address:
Telephone:
City, State & Zip:
Fax:
Current Insurance Information
Insurance Company Name:
Policy Exp. Date:
Amount Insured for:
Mortgage Amt:
Premium Amt:
Term:
Any Claims in Last 3 years?
General Information About Home:
Year home built:
Total Square Feet:
Yrs @ present address:
Home Construction:
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Frame
Brick
Masonry
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Home Type:
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1 story
1 1/2 story
2 story
Split level
Bi-Level
Other
Garage Type:
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1 car
2 car
3 car
Car Port
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Flood Zone?:
Garage:
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Attached
Detached
Basement
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Elevation ?:
# of Fireplaces:
# of Bedrooms:
Exterior:
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Deck
Porch
Patio
Screen Patio
# of Bathrooms:
Additional Information
Swimming Pool?:
Pool Fenced:
Diving Board:
Galvanized Pipes:
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$100,000
$300,000
$500.000
$1,000,000
Smoke Detector:
Security System:
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Less than 1,000 ft
More than 1,000 ft
Heating System:
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Less than 5 miles
More than 5 miles
Home Type:
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1 story
1 1/2 story
2 story
Split level
Bi-Level
Other
Replacement cost of personal items:
Any business conducted in home:
List values of any jewelry, furs, or speciality items:
List pets & breeds:
Do you want to include Flood Insurance?:
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Yes
No
Additional Comments
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By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.
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