Flood Insurance
Name *

First
Last
Phone Number *

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Email *
Please use the email you would want us to get information back to you with.
Homeowners policy number
We will need EITHER your current homeowners policy number OR your complete address
Address

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Building and Contents Coverage (Without Basement)
 $20,000.00 / $8,000.00 / $129.00 
 $30,000.00 / $12,000.00 / $160.00 
 $50,000.00 / $20,000.00 / $211.00 
 $75,000.00 / $30,000.00 / $247.00 
 $100,000.00 / $40,000.00 / $274.00 
 $125,000.00 / $50,000.00 / $294.00 
 $150,000.00 / $60,000.00 / $313.00  
 $200,000.00 / $80,000.00 / $343.00  
 $250,000.00 / $100,000.00 / $365.00 
Amounts Indicate Coverage for Building / Contents / & Premium. Please Choose the amount of coverage.
Contents Coverage Only
 $8,000.00 / $68.00 
 $12,000.00 / $92.00 
 $20,000.00 / $128.00 
 $30,000.00 / $147.00 
 $40,000.00 / $164.00 
 $50,000.00 / $181.00 
 $60,000.00 / $198.00  
 $80,000.00 / $218.00  
 $100,000.00 / $238.00 
Amounts Indicate Coverage for Contents / & Premium. Please Choose the amount of coverage.
Credit Card Type *
 AMEX 
 VISA 
 MASTERCARD 
 DISCOVER 
Credit Card Number *
CSV CODE *
AMEX uses a 4 digit code
Amount to Charge *
CC Expiration Date *
Authorization
 I agree 
I agree to allow InsurTexas to charge my account the above Credit Card for the coverage chosen. FEMA guidelines state that any property in the Preferred Risk Zone (aka X Zone) takes 30 days from payment processing for the coverage to be in effect and that there is NO refunds unless the property is sold or property ownership transfered mid term with documentation. The policy is not considered bound until you receive an email with your paid in full receipt from InsurTexas's office.
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