ALOHA INSURANCE SERVICES

Flood Insurance Quote
Policy Holder Information
Name(s) to appear on Policy
Mailing Address
City, State and Zip
Telephone Number
Fax Number
E-Mail Adddress
Property Information
Physical Address
City, State and Zip
Date of Construction
Name of Condo Complex / Project
Tax Map Key Number (TMK)
If your property does not have a TMK Number, please provide the following: Year built, square footage of living area, square footage of garage or carport, square footage of any lanais or porches, description and square footage of any other structures attached to the house.
Amount of coverage desired for the structure
Amount of coverage desired for the contents

Occupancy Information
How many rooms? 5 5 1/2 6 6 1/2 7 7 1/2 8 8 1/2 9 9 1/2 10 10 1/2 11 11 1/2 12 12 1/2 13 13 1/2 14 14 1/2 15	Number of stories? 1 2 3 4 5 6 Over 6
Flood Zone A A1-30/AE AH AO A99 V V1-30/VE B,C, & X D Not Sure	Who occupies this structure? Owner Renter Business Under Construction Vacant
How many regular occupants? 1 2 3 4 5+	What part of the year occupied? Year Round Seasonal Never
Do you have a garage? No Garage Carport Attached One Car Attached Two Car Attached Three Car Unattached One Car Unattached Two Car Unattached Three Car	How many bedrooms? 1 1 1/2 2 2 1/2 3 3 1/2 4 4 1/2 5 5+
Type of exterior wall Adobe Aluminum/Vinyl Siding Asphalt Brick Veneer Cement Fiber Clap Board Concrete Block Log Siding Logs Mineral Fiber Painted Masonry Precast Concrete Precast Stone Slump Block Split Block Solid Brick Solid Stone Stone Veneer Stucco on Frame Stucco on Masonry Wood Shakes Wood Siding Other / Not Sure	Type of roof Architectural Shingles Asphalt or Fiberglass Shingles Built-Up/Tar and Gravel Clay Tile Concrete Tile Corrugated Steel Mineral Fiber Shakes Mission Tile Rock Roof Roll Roof Rubber Roof Slate Tin Wood Fiber Shingles Wood Shake Other / Not Sure
Type of Foundation Crawl Space Piers/Pilings/Stilts Slab on Grade Walkout Basement Wood Foundation Basement Unfinished Basement Other / Not Sure	Rate your own credit Excellent Minor problems Bad Horrible
Rental Property Information
Will you be renting any part of the property?	No Yes
If so, how many tenants?
Short term or long term rentals?	Long Term Short Term
Will the property be furnished?	Yes No
Amount of coverage desired for furnishings

Other Information
Are there any structures requiring coverage that are not attached to the main building? (Detached garage, storage buildings, etc.)? If yes, please provide details.
Any prior losses or claims in the ast 5 years? If yes, please provide details.
Any other information you think may be pertinent, or, any questions or comments.