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George Franklin Insurance
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Step
1
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General Information
Name:
*
First
Last
DOB:
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Phone:
*
Email:
*
Physical Address:
*
City:
*
State:
*
Please Select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP Code:
*
Next
Home Information
New Purchase?
Closing Date:
*
Prior Claims:
Yes
No
# of Claims:
Selected Value:
0
Mobile Home?
Manufacturer:
Serial Number:
Length:
*
Width:
*
Home Type:
Single Wide
Double Wide
In A Park?
Park Name:
*
Amount of Insurance Requested:
Add Attachment
Type:
*
Length:
*
Width:
*
Add Attachment
Type:
*
Length:
*
Width:
*
Add Attachment
Type:
*
Length:
*
Width:
*
Type of Residence
Please Select...
Primary
Rental (Annual)
Rental (Short-Term)
Year Built:
Please Select...
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
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1981
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1979
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1908
1907
1906
1905
1904
1903
1902
1901
1900
Square Feet:
Roof Age:
Roof Age:
0
Years Old
Pool?
Yes
No
Type:
*
Inground
Above
Extras:
*
Screened
Fenced
Burgular Alarm?
Yes
No
Gated Community:
Yes
No
Dogs?
Yes
No
Restricted Breeds?
Yes
No
Restricted dog breeds include Pit Bulls, German Shepherds, Akitas, Staffordshire Terriers, Chows, Alaskan Malamutes, Doberman Pinschers, Great Danes, Siberian, Huskies, Rottweilers, Presa Canarios and Wolf hybrids.
NOTE:
Don't be discouraged to disclose if you own a restricted dog breed. We will do our best to help find you coverage regardless.
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Next
Inspections
4-Point Inspection?
4-Point Inspection
Click or drag a file to this area to upload.
Wind Mitigation?
Wind Mitigation:
Click or drag a file to this area to upload.
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Next
Current Insurance Carrier
Name of Carrier:
Expiration Date:
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YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
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1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
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Desired Coverage / Deductibles (If Applicable):
Submit
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