Please complete the form below, Jordan Weiss will get an email with your information, and get back to you ASAP. Make sure to complete all fields as accurately as possible. At the bottom you can attach the documents necessary to quote you, such as current declarations page (if you currently have insurance), inspections (windstorm mitigation and four point), and any other documents (alarm certificate) to help us get you all the credits available. Privacy Policy

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Jordan Weiss can be reached directly at:

954-363-7404

jordan.weiss@alllines.biz

Contact Information
First Name:  
Last Name:  
Phone Number:  
Email Address:  
Date Of Birth:  
Property Information
Property Address:  
Apt # :  
Property City:  
Property State:  
Property Zip:  
New Purchase:  
Construction Information
Year Built:  
Square Feet:  
Roof Year:  
Roof Shape:
Click To Select Your Roof's Shape
 
Property Usage:  
Structure Type:  
Construction Type:  
Coverage Information
Effective Date:  
Cost To Rebuild Home?  
Cost To Replace Personal Property?  
Hurricane Deductible:  
Non-Hurricane Deductible:  
Opening Protection:  
Current Carrier:  
Current Annual Premium:  
Thanks for the referral! How can we reach you?
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If you have your current policy declaration page, wind mitigation inspection or any other inspections for the property, please upload them here.