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Insurance Discussion Form

Use this form to discuss your insurance coverage with your agent. Having adequate coverage now will help you recover more rapidly from a catastrophe.

Insurance Agent: __________________________________________

Address: _________________________________________________

Phone: __________ Fax: ___________ Email: ___________________

INSURANCE POLICY INFORMATION

Type of Ins	Policy #	Deductibles	Policy Limits	Coverage Type

Do you need Flood Insurance?	Yes	No
Do you need Earthquake Insurance?	Yes	No
Do you need Business Income & Extra Expense Insurance?	Yes	No
Other disaster-related Insurance?	Yes	No

Source: READY.GOV