Enter requested coverage amount in $100 increments
minimum: $0 / maximum: $250,000
Click Here to learn about contents coverage.
Enter $0 if contents is not desired
You can quote your own policy using the
Calculate Your Own Premium
page AL, AZ, CA, CO, CT, DE, FL (Coverage NOT available in Monroe county), GA, HI, IA, IL, IN, KS, MA, MD, ME, MI, MS, NC, NE, NH, NJ, NM, OH, OK, OR, PA, RI, SC, TX, VA, VT, WA, WI, WV. Because underwriting approval is only good for 60 days, applications should only be completed when you are ready to purchase coverage.
TFIA’s Private Market Flood program offers FOUR solutions to ever-increasing annual flood insurance premiums: Rate-Lock allows you to pay the same rate for two years with one year rate lock or three years with two year Rate-Lock (Premium is paid annually). Additionally, Pre-Pay in full for a two year policy guaranteeing no increase for the second year of the policy or Pre-Pay three years premium guaranteeing no increase for three years.
One Year Term
One Year with One-Year Rate-Lock
One Year with Two-Year Rate-Lock
Two Years (Pre-Paid)
Three Years (Pre-Paid)
Purchase Requirement Date
* Purchase Requirement Date
Please enter your loan closing date or the date of your expired or expiring flood insurance policy. If you have selected “Other – 14 Day Waiting Period,” please enter 11/11/1111. Your purchase requirement date cannot be more than 75 days after the date of application (today). The required waiting period is 14 days unless the date of a loan closing is sooner, you have an active FEMA policy, or a FEMA policy unpaid renewal within the 30 day grace period (in which case a no known loss statement will be required,
NO COVERAGE IS BOUND UNTIL THE APPLICATION IS APPROVED BY UNDERWRITER AND THE FULL ANNUAL PREMIUM IS RECEIVED.
Insured First Name
Insured Last Name
2nd Insured First Name
2nd Insured Last Name
County in Which Located
Mailing Address (if different than property)
Mailing Address Line 2
Mailing Address City
Mailing Address State
Mailing Address Zip Code
Property Owner Phone Numbers (not insurance agent’s phone number)
Current flood Insurance carrier (if any)
Date of Construction
* Date of Construction
Slab on Grade - Diagram #1
Basement - Diagram #2
Split Level Slab - Diagram #3
Split Level Basement - Diagram #4
Elevated Building with No Enclosure - Diagram #5
Elevated Building with an Enclosure - Diagram #6
Walkout Basement - Diagram #7
Crawlspace - Diagram #8
Below Grade Crawlspace - Diagram #9
First Mortgagee Address
First Mortgagee Address Line 2
First Mortgagee City
First Mortgagee State
First Mortgagee Zip Code
First Mortgagee Loan Number
Second Mortgagee Address
Second Mortgagee Address Line 2
Second Mortgagee City
Second Mortgagee State
Second Mortgagee Zip Code
Second Mortgagee Loan Number
Acknowledgement of Potential loss of fema subsidy
acknowledgement of availability of coverage
please answer yes if the following statements are TRUE and no if the following statements are FALSE.
please answer yes if the following statement is TRUE and no if the following statement is FALSE.
Comments and/or Any Additional Information
Thank you! An underwriter will review your application shortly and respond to you within one business day. If you have an immediate need that requires a response sooner, please call us at 877-356-6348. We look forward to assisting you.