Serving Clients Since 1927

Omaha (402) 398-9009 | Kearney (308) 234-5258

Flood Insurance Form

    Complete this form for a Flood Proposal.

    Name

    Mailing Address

    City

    State

    Zip Code

    Telephone

    Email Address

    Property Location

    Property Address

    City

    State

    Zip Code

    Mortgage

    Lender Name

    Loan Number

    Mailing Address

    City

    State

    Zip Code

    Rating Information

    Building Occupancy
    Single Family2-4 FamilyOther ResidentialNon-Residential

    Basement\Encloser (all four sides underground)
    NoneFinishedUnfinishedl

    Building Type (include basement if any)
    1 Floor2 Floors3 FloorsSplit-levelMobile home

    Is the property owned by the government?
    NoStateFederal

    Is the building in the course of construction?
    NoYes

    Years of Construction

    Contents Located
    Basement onlyBasement and aboveLowest floor above groundLowest floor above ground and higherAbove ground level, more than one floor

    Are contents household?
    YesNo

    if no, describe:

    Replacement Cost of Building

    Amount of Insurance

    Residential Building (up to $250,000)

    Residential Contents (up to $100,000)

    non-Residential Building (up to $500,000)

    non-Residential Contents (up to $500,000)

    [recaptcha]

    Marcotte contracts with DataShield to handle and destroy all customer and proprietary information. DataShield is certified through the National Association for Information Destruction (NAID) with an AAA designation.


    PLEASE NOTE: The information being provided is strictly as a courtesy. When you access one of these web sites, you are leaving our web site and assume total responsibility and risk for your use of the web sites you are linking to. We make no representation as to the completeness or accuracy of information provided at these websites. Nor is the company liable for any direct or indirect technical or system issues or any consequences arising out of your access to or your use of third-party technologies, web sites, information and programs made available through this website.