You can receive a flood quote by clicking
on
GET FLOOD QUOTE and
printing the
page that opens up. You will need Adobe
Reader to open
the page.
Or, complete the request
form and click
the send button.
Name of Insured:
Property Location:
Mailing Address (if different):
Phone No.:
Fax
No.:
E-mail:
Coverage Amount:
Building Levels:
Basement:
If condo or
apartments, # of
Units in the Building:
Square Footage:
Year Building
was built:
Building Type:
Lender Name:
Loan No.:
Lender Address:
Fax
No.:
Is Your Lender Requiring This Coverage:
CREDIT CARD AUTHORIZATION:
(use this form to pay your insurance premium by credit card.)
Card Number.:
Expiration Date:
Total Premium:
Name of Insured (if different from
cardholder):
Cardholder Name (print as it appeared on
the card):
Cardholder Phone Number.:
Cardholder Signature:
(For official use only)
Date of charge:
Credit card authorization:
Policy No.:
This policy is not subject of cancellation for reasons
other than those set forth in the National
Insurance Flood Program
rules and regulations. In matters involving billing disputes,
cancellation is not available other than billing processing
error or fraud.
To send information,
click
To reset to initial value, click
CLICK ON ME FOR FLOOD INFO
Make check payable to:
Main Street Insurance Agency
Or by Credit card, fax to: 718-848-1375
Or mail
check to:
Stanley K. Raj
Main Street Insurance Agency
108-05 Liberty Avenue,
Richmond Hill, NY 11419
Tel: 718-848-7610.
Fax:718-848-1375
