How can we help you? Step 1 of 5 20% Are you a current client of TWFG - DelaFuente Insurance Services?(Required) No, I'm a new client Yes, I'm a current client What effective date do you want for your new insurance?(Required) MM slash DD slash YYYY Your Name(Required) First Last Entity name that owns/will own the property(Required)Preferred Email(Required) Preferred Phone Number(Required)Your Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Property address to be quoted:(Required)If you need a quote for more than one property right now, we will gather that information on your Discovery Call. Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code How many residential units on the property?What is the estimated occupancy (%)?(Required)Any special classes of tenants?(Required)Check any box that applies Student Housing Designated Elderly Housing Subsidized Housing / Sec 8 None of the above Do you have a lender or mortgagee for this property?(Required)We will gather the name and address for your lender later, if applicable. Yes, I have a lender/mortgagee No, I do not have a lender/mortgagee Full Lienholder/Mortgagee Clause(Required)If you don't know it, just put "TBD" and we'll get it from you laterDo you need a companion FLOOD INSURANCE proposal for this property? No Yes How did you first hear about RiskWell? Personal Referral Google Search Local event Facebook Group/Post YouTube video Word of mouth Who referred you to us?(Required)What else do we need to know to deliver you an outstanding experience?Please upload all relevant documents here: Drop files here or Select files Max. file size: 5 MB, Max. files: 5. Communication Consent(Required)TWFG - DelaFuente Insurance Services is committed to respecting our current and future clients' privacy and communication preferences. So that we may remain compliant with state and federal regulations, we need your expressed permission to communicate with you using phone, text and email as needed. You may opt-out of all future communication at any time by making your preferences known to us. TWFG - DelaFuente Insurance Services operates by the simple rule of "treat other people the way you want to be treated." I authorize TWFG - DelaFuente Insurance Services to communicate with me using the information provided on this form for the purpose of assisting with my insurance program..
