West Coast Global InsuranceServices

www.insuremewc.com

West Coast Global Insurance ServicesProvides the Most Comprehensive California Earthquake Protection offered by Top Rated Insurance Carriers.

West Coast Global Insurance Service

Ca.Lic. #0E50745

USA - (844) 924-2004 (U.S Toll Free)

Request Quote - West Coast Global Insurance ServicesProvides the Most Comprehensive California Earthquake Protection offered by Top Rated Insurance Carriers

INSURED DETAILS

BENEFICIAL OWNERS DETAILS

CONTACT DETAILS

I have Whats App? : Yes No

LOCATION DETAILS

CURRENT HOMEOWNERS INSURANCE DETAILS.

Please list the preferred amount of coverage below for the requested residential earthquake policy. Coverage A must match what is listed on the current Homeowners policy!

Deductible Desired(Select all that apply)

Select All      
Palomar I Cat QBE Universal
GeoVera Coastal Select Aegis
Select All      
Comprehensive 2% Comprehensive 5% Comprehensive 10% Comprehensive 15%
Comprehensive 20% Standard 15%

Please note: we do have carriers that offer a 7.5%, 12.5%, and 25% deductible option. If you are interested in receiving a quote with this option as well, please add to the "additional notes" section below

Pool Endorsement Needed? *

Year Built *

Total Square Feet *

Is the home retrofitted if built before 1973? *

Does the dwelling have existing earthquake damage? *

If yes, please provide date of loss & when damage was repaired

Is the dwelling under construction or renovation? *

Is the dwelling on the historical register? *

Does the Dwelling have any log and/or Adobe siding? *

Select ONLY if the % of Brick, Brick Veneer, Concrete Block, Stucco on Block, Stone or Stone Veneer siding type is greater than 30%

Is the dwelling within 500 ft from the beach? *

Unit Type *

Please Select the Number of Units *

Please Select the Number of Levels (Include Basement or Garage) *

Foundation Type *

If Basement, please list the total square footage of Basement

Does the dwelling have Cripple Walls? *

If yes, are the Cripple Walls braced with plywood?

Is the water heater secured to the building frame? *

Is the Foundation Bolted? *

Construction Type *

Please note: we do not have a market for Mobile, Modular, Prefabricated, Adobe, Log, or Masonry Homes

Slope *

Garage Type *

Garage Size *

Comments:

disclaimer

I understand that West Coast Global Insurance Services offers this informal application/questionnaire to collect general information, and it does not guarantee insurance coverage. Submitting this application/questionnaire does not provide immediate insurance coverage. Coverage limits may change upon receipt of a formal insurance quote, and I am responsible for reviewing coverages and policy conditions.

I confirm that the information I provided is accurate. This information is provided to facilitate the issuance of an insurance policy, but no coverage is offered at this time. I consent to West Coast Global Insurance Services contacting me via telephone calls, text (SMS & MMS), and email. Consent is not a condition of purchase, and message and data rates may apply.

By providing my phone number, I agree that West Coast Global Insurance Services may send text messages to my wireless phone number for any purpose. Message and data rates may apply. We will send one SMS as a reply, and you can opt-out by replying 'STOP.' For more information on how your data is handled, please visit our Privacy Policy. (PRIVACY POLICY)
Checking this box serves as my digital signature.

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