Quote Form

Occupancy Information:

Have you purchased the home within the last 3 years?

Yes
No

Prior Address

Occupancy:

Primary Residence
Secondary
Seasonal
Rental/Investment Property

If Rental:

Annual
Semi-Annual
Short-Term
Secondary Occupancy with Short Term Rental

Mailing Address

What is the daily rental rate or approximate daily rate:

Duration of short-term rental:

Daily
Weekly
Monthly

Mortgage:

Yes
No

Will it be titled in an LLC or Trust?

Yes
No

Name of LLC or Trust

Lending Institution:

Lender:

Year Built:

If 2002 or below, need wind mit. If 1989 or below, need 4 point.

Inspections?

Wind Mit
4 Point
Elevation Cert

Roof Year:

Age of Hot Water Heater:

Dogs?

Yes
No

If yes, list breed(s):

Claims in the past 5 years?

Yes
No

If Yes, complete the following:

Approx. Date:

Description:

Approx. Amount Paid:

Approx. Date:

Description:

Approx. Amount Paid:

Have you worked with HH Insurance in the past?

Yes
No

New purchase or Not Insured - no dec page required.

How did you hear about us?*

Other - How did you hear about us?*

Who's your realtor?

Who's your lender?

Who's your friend?

Who's the Employee?

Request Current Declarations

Client will Email or text pdf documents to sales@hhinsgroup.com
Client will send photo of documents via email or text to sales@hhinsgroup.com
Client will fax documents to HH service fax number (727)601-0988
Client will mail documents to HH home office 3443 1stAve N St. Petersburg, FL 33713
Client denied request for declarations page and team member reassured client dec is for apples-to-apples coverage comparison.

Quote Request Taken By*

Notes:

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Personal Information:

Occupancy Information:

Phone	Email

Name	Phone	Email	Date of Birth