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. 

On-Line Application
 Property Information
 

Property Address

  
  Street Address:  
  City:  
  State: Zip Code:  
  County:  
Property Type:
Property is used as:
  Months occupied during the year:  
  Tenants: Yes       No  
What year was the house built?
When was the last update to the following items?
A/C-Heating: 
Plumbing:
Roof
Electrical
Years Owned:
Estimated square footage under A/C:  sq. ft.
Floors excluding basement:
Number of bedrooms:
Number of bathrooms:
  Type of Roof:  
  Roof Covering:  
 

Mobile Homes Only:

  
 

Length & Width:

        L:         W: 

 
 

Manufacturer:

  
 

Skirting:

  
 

Name of Park:

 
 

Porches:

        

 
 

Utility Shed:

        

 
 

Carport:

        L:         W: 

 
 

Site/Lot:

        

 
Garage:
Condo/Townhouse – Firewall? Yes       No
A/C - Heating:
Type of exterior walls:
Within 1,000 feet of fire hydrant?
Distance to manned fire dept.:
Security system installed?
Age of Roof:
    Is the Property in a Gated Community? Yes       No  
    Premium 
Escrowed:		 Yes       No  
    Flood Zone: Yes       No  
    City Limits: Inside       Outside  
    Is the property over 5 acres? Yes       No  
    If over 5 acres, what is the Land Use?  
    Hurricane Shutters Yes       No  
    Type of Shutters:  
    Shutter Manufacturer:  
    Distance to Intracoastal: miles  
   

Swimming Pool Information:

  
   
N/A  Above Ground 
In-Ground Screened
Fenced  Diving Board
Water Slide

Check items below that are part of the residence (please check all that apply):
Fireplace Deadbolt Locks
Wood Stove Uncovered Patio/Deck
Smoke Detectors Covered Patio/Deck
 
     
     
     
 New Purchase Information (if Applicable)
Closing Date:
  Purchase Price:
  Lender Company Name:
  Lender Representative:
  Lender Contact Phone #:
R.E. Agency Name:
  R.E. Agent Name:  
  R.E. Agent Phone:  
  Title Company Name:  
  Title Company Phone:  
 Current Insurance Information
Current insurance company:
  When does policy expire:
Any claims in the last 5 years?
  Has your policy ever been cancelled? Yes       No  
  Requested Coverage
Requested dwelling coverage?
Requested deductible:
   
Requested liability: 
Hurricane Deductible*: