Call Bankers Alliance Insurance Group, Inc. at

1-800-568-5163

 for your coverage today!

B.A.I.G., Inc. is a proud member of the Independent Insurance Agents & Brokers of America. 

Residential Property Application
  Contact Information
  First Name:  
  Last Name:  
Spouse/Insured 2 First Name
  Spouse/Insured 2 Last Name  
Referred By:
Your Email:

Phone Number:

Alternate Telephone:

  Best Time to Call:  
Your BAIG Agent (if applicable)
 
 Property Information

Property Address

  
Street Address:  
City:  
State: Zip Code:  
County:  
Property Type:
New Purchase? Yes   No
Property is used as:  
Is the Property in a Gated Community? Yes       No  
What year was the house built?
Is the property over 5 acres? Yes       No  
Type of construction:  
    Do you own any dogs?  Yes     No  
    What breed(s) are they?  
Garage:
Within 1,000 feet of fire hydrant? Yes    No    Unknown
Distance to fire dept.:
Security system installed?
Age of Roof:
   

 

Swimming Pool Information:

  
   
N/A  Above Ground 
In-Ground Screened
Fenced  Diving Board
Water Slide
 
     
     
     
 Current Insurance Information
Current insurance company:
  Current Policy Coverage:
  When does policy expire:
Any claims in the last 5 years?
  Hurricane Deductible:  
All Other Perils (AOP) Deductible:

         

 

Copyright © 2006-2009 Bankers Alliance Insurance Group, Inc.  All Rights Reserved.
10655 S. US-1 * Port St. Lucie, FL 34952 * Toll free: 800-568-5163 * Office: 772-337-9787 * FAX: 772-337-9087

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