Herbert M. Sheaner, Jr. 
Insurance Agency

Tell us about you.

First name
*Last name
Street address
Address (cont.)
City
State	Texas
Zip code
County
Work phone
Home phone
Fax
*Email
Preferred means of contact	(choose one) Email Work phone Home phone Fax Mail

Tell us about the location of your property.

Township, Boro, Community Name
*Street address (no PO Box)	(choose one) Street Road Court Drive Blvd Ave Circle Other
Address (cont.)
*City
*County/Parish
State	Texas
*Zip code
Lot, block, subdivision (if known)

Tell us about the building and contents location to establish the rating.

*FIRM zone	(choose one) Unknown A B, C, or X A1-30 AH A0 A99 V V1-30 D AE VE ARA ARO ARH ARE AR
*Building occupancy	(choose one) Single family 2 to 4 families Other residential Nonresidential
If you answered "Non-residential" about building occupancy, provide description of use
	Is the building located in an Unincorporated Area Is the building in the Course of Construction Is the building Government Owned Is the policy required for Disaster Assistance Does the Basement have Machinery and Equipment
*Building type	(choose one) 1 floor 2 floors 3 or more floors Split-level Condominium Townhouse/Rowhouse Manufactured/Mobile home-Single Wide Manufactured/Mobile home-Double Wide
If you answered "Condominium" about building type, select from drop down menu	(choose one) Single unit Association-Low Rise Association-High Rise If Association, number of units
*Foundation type	(choose one) Built on Slab at Ground Level Sub-Grade on all sides - unfinished Sub-Grade on all sides - finished Elevated - with enclosure Elevated - without enclosure
Note: Sub-Grade means any area of the building, including any sunken room or sunken portion of a room, having its floor below ground level on all sides. The policy provides only limited coverage in basements and for the enclosed areas below elevated buildings.
*Garage Information	(choose one) None Attached Detached Built In If attached or built-in,  Does Garage contain Machinery or Equipment? Is Machinery and Equipment elevated to the       reference floor level? Is Garage used for other than parking?
*Property construction date (month/day/year)
*Is building principle residence?	(choose one) Yes No
*During the period of ownership, has property owner received 2 or more flood insurance claim payments or flood disaster relief payments (including loans and grants) of $1,000 or more?	(choose one) Yes No
*Contents location	(choose one) Basement and above Enclosure and Above Lowest floor only above ground level Lowest floor above ground level and higher Above ground level more than one full floor In Mobile Home
Lowest floor elevation (if known)
Base flood elevation (if known)

Tell us about the amount of insurance you want.

*Policy Type	(choose one) New Renewal Rollover
*Building replacement cost	$
*Amount Building Coverage	$
*Amount Contents Coverage	$

Please provide any additional information or comments.