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Kopec Flagler County Chamber

Flagler County’s Preferred Insurance Agency

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Home  |  Auto  |  Life  |  Marine  |  Business

Home Insurance Quote

Business Name:
Work Phone:
Home Phone:
Cell Phone:
How Did You Hear
About Us?:
Referral (please specify)
Internet (please specify)
Community First Yellow Pages (employee group photo on
  cover, glossy pages)
Flagler Chamber of Commerce Phonebook (scenic
  beach/dolphin photo cover)
Yellow Book Phonebook- Flagler County Directory &
  Shopping Guide (yellow cover)
AT&T (Bellsouth) Phonebook
Other (please specify)
Structure Replacement Value:
(current policy limit)
Current Policy Provider:
Current Premium:
Has the current policy lapsed, cancelled or non-renewed?
Current Policy Expiration Date:
Year Built:
Roof Style: Hip   Gable
Monitored Alarm Systems:  
Fire? Yes   No
Burglar? Yes   No
Gated Community? Yes   No
Dogs? Yes   No
If yes, number and type:
Please indicate any scheduled property (high value jewelry, artwork, etc.) needed?
Flood Policy? Yes   No
Type of Residence: House   Condo   Townhome
Duplex   Manufactured Home
Type of Residence: Primary   Secondary   Rental   Seasonal
Please indicate prior claims or renovations:

Don't forget to have our office review your entire insurance portfolio
including auto, home, marine, life, and business insurance.

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