Khalsa Insurance Agency
 
California License # 0F89805
 
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Flood Insurance Quote Form...
 
Full Name:
Phone:
Home Phone Day Time Phone
   
E-Mail Address:
Insured Person 1 Details:
Name Date of Birth SSN Occupation
       
Insured Person 2 Details:
Name Date of Birth SSN Occupation
       
   
  Property Location Info.
   
Property Address:
City:
State
ZIP:
   
  Property Exterior Info.
   
Year Built:
Square Foot:
1, 2 Storied or more:
Roof Type:
Age of Roof:
How many Cars can the Garage Accommodate?
Garage Attached or Detached?
Swimming Pool:
Yes / No Fenced Above Ground
     
   
  Property Interior Info.
   
How many Bedrooms?
AC / Heaters:
How many Bathrooms?
Are there any Fireplaces?
If yes How many Fireplaces?
Special Features:
   
  Additional Legal Info.
   
Any claims in the last 3 years:
Date Type of Claim Payout $
     
   
  Mortgage Info.
   
Name:
Loan Number:
Address:
   
 
 
 
 
FLOOD Insurance
   
   
 
Do I Need Flood Insurance?
   
Flood Insurance Quote
   
   
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    Legal Information   |   Khalsa Insurance Agency Inc. 2020