Thank you for your interest in receiving a homeowners quote from My Florida Insurance. This form should only take about 5 minutes to complete. Don't worry if you don't have everything. You can always click the "Save and continue later" button below. We'll email you a private link to pick up where you left off.

How did you hear about our agency?*

Date you want this policy to start*

Name*

Insured First Name Insured Last Name

Mobile Phone*

Email*

Date of Birth*

Occupation*

Personal Information

Marital Status*

Co-Insured Name

First Last

Co-Insured Date of Birth

Co-Insured Phone

Co-Insured Email

Co-Insured Occupation

Property Information

Is this a new Purchase?*

PROPERTY ADDRESS*

Street Address City State ZIP Code

Is the property titled in a name other than your personal name(s)?*

(i.e. Trust, LLC, Corporation, etc.)

No

Yes

Name on title of property if other than you.

Will this be your primary or secondary home?*

Do you plan on renting out the home?*

Property Information

Year Home Built*

Roofing Material

Year Roof Updated*

Construction Type

Does the roof have any solar panels?*

Yes

No

How many solar panels

Current value of solar panels

Purchase Date*

Purchase Price*

Mailing Address

Mailing Address*

Same as Property Address?

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of years at this address

Previous Address*

Street Address City State Zip Country

Upload Current Policy

To better assist us in comparing your current coverage to our proposal, please upload a copy of your current homeowners policy.

If this is not a new purchase, we will need a copy of your current policy. Would you like to upload this now?*

Yes

No

Name of current insurance carrier*

Why we need this: We represent many different carriers and we don't want to quote your insurance with the same carrier.

Current Policy Upload*

You may upload up to 10 policy documents. Only .pdf file types accepted.

Drop files here or

Accepted file types: pdf, Max. file size: 10 MB, Max. files: 10.

Claims and Rating Information

Reported Claims on any property owned in the last 5 years?*

Have you had any insurance lapse (30 days or more), cancel, or non-renew in the last 3 years?*

No

Yes

No prior insurance

Optional Discounts

The following discounts are available. Please check all that apply.

Central Station Fire Alarm

Central Station Burglar Alarm

Water Leak Sensors

Home Security System (Cameras, RING, etc.)

HVAC Maintenance Contract

Please let us know what unique features this property has (ie. elevator, backup generator, server room, etc.)

More Property Info

Great job! Keep going.

Do you have any pets?*

Yes

No

Please list all your pets. If you have dogs please list the breed(s).

Last Step

You're almost done!

Would you like to receive an auto quote as well to maximize your savings?*

Yes

No

Let's discuss

Would you like a quote from a specific agent?

Is there anything you want us to know?

All the above information is accurate and true to the best of my knowledge.*

Yes

Phone

This field is for validation purposes and should be left unchanged.

Personal Information

Property Information

Property Information

Mailing Address

Upload Current Policy

Claims and Rating Information

Optional Discounts

More Property Info

Last Step

Social Media

Company

Resources

For Clients

Get a Homeowners Insurance Quote

Personal Information

Property Information

Property Information

Mailing Address

Upload Current Policy

Claims and Rating Information

Optional Discounts

More Property Info

Last Step

Social Media

Company

Resources

For Clients