How can we help you? 1Contact Info2Property Info3Wrap-Up Info Are you a current client of TWFG - DelaFuente Insurance Services?(Required)No, I'm a new clientYes, I'm a current clientWhat effective date do you want for your new insurance?(Required) Month Day Year Your Name(Required) First Last Your Date Of Birth(Required) MM slash DD slash YYYY Is the property held in your personal name or another legal entity (LLC, etc...)(Required)Held in my personal nameHeld in another entity (LLC or other)Entity Name(Required) Your Email(Required) Your Phone Number(Required)Your Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Property address to be quoted:(Required)If you need a quote for more than one property right now, we will gather that information on your Discovery Call. Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Property County Building Type(Required)Single Family ResidenceMobile Home2-4 UnitsMultifamily (5+ units)Commercial PropertyCondoOther Asset ClassHow many units does this property contain?(Required)What is your intended use for this property?(Required)Long-Term RentalFlip/RehabShort-Term Rental (AirBNB/VRBO)VacantWhat policy term do you want?6 months12 monthsWhat kind of purchase is this?(Required)Conventional PurchaseCreative Financing MethodWhat kind of Creative Finance Method are you using?(Required)Sub 2Seller FinanceWholetailIs there a lender or mortgagee for this property?(Required)Yes, there is a lender/mortgageeNo, there is not a lender/mortgageeLender/Mortgagee Name(Required)Lender/Mortgagee Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Full name and mailing address for underlying seller(Required)Coverage Amount Needed ($)(Required)For a "flip" property, use the purchase price + your renovation estimate to determine the property coverage amount. How will this policy be paid for?(Required)I'm paying through a title company or escrow accountI'm paying for this policy directly Do you need a companion FLOOD INSURANCE quote for this property?(Required)Yes, please help me get a flood quoteNo, I am declining the offer of a flood quoteHow did you first hear about RiskWell? Personal Referral Google Search Local event Facebook Group/Post YouTube video Word of mouth Who referred you to us?(Required) Our team is also well equipped to help with your personal insurance needs (Home & Auto Insurance + whatever else you need.) After we're done with delivering this real estate quote, can we review your personal insurance options?(Required)Yes, I'd like a review of my personal insurance options.Yes, but not now. Please ask me about this in the future.No, I am declining the offer of a personal insurance review.Date to contact you about reviewing your personal insurancePlease select the future date you want us to contact you on, so we can perform a full review of your personal insurance options. MM slash DD slash YYYY What else do we need to know to deliver you an outstanding experience?Please upload all relevant documents here: Drop files here or Select files Max. file size: 5 MB, Max. files: 5. Communication Consent(Required)TWFG - DelaFuente Insurance Services is committed to respecting our current and future clients' privacy and communication preferences. So that we may remain compliant with state and federal regulations, we need your expressed permission to communicate with you using phone, text and email as needed. You may opt-out of all future communication at any time by making your preferences known to us. TWFG - DelaFuente Insurance Services operates by the simple rule of "treat other people the way you want to be treated." I authorize TWFG - DelaFuente Insurance Services to communicate with me using the information provided on this form for the purpose of assisting with my insurance program..UntitledFirst ChoiceSecond ChoiceThird Choice
