Latino Tax and Express Services Inc.

Services
Service Request
Insurance Services
Tax Resources
Client
About Us

Homeowners

First Name

Last Name

Address

City

State

Postal code

Date of birth

Email *

Phone *

Education

Marital Status

Do you have a co-applicant?

Yes

No

First & Last Name

Co-applicant Marital Status

Relationship to applicant

Co-applicant Education

Co-applicant Date of Birth

Property

Year built

Square footage

Number of stories

Number of separate living units

Purchase date

What's your home's estimated market value?

Home safety features discount

Tell us about your home's safety features. Select all that apply.

Number of fireplaces and wood burning stoves

Interior details

Are any of these wood burning stoves ?

Yes

No

Number of bathrooms? (Full)

Number of bathrooms? (Half)

Bathroom quality

Kitchen quality

Primary foundation type (Exterior details)

Do you have a basement?

Yes

No

Primary exterior wall type

Roof shape

Primary roof composition

What year was your roof built or last replaced?

Do you have a garage?

Yes

No

What type of garage?

Size

How many people live in your home?

Does anyone in your home smoke?

Yes

No

Do you have any dogs?

Yes

No

Have any of your dogs ever bitten anyone?

Yes

No

Do you own any wild or exotic animals?

Yes

No

Do you operate a business from your home?

Yes

No

Do you currently have property insurance?

Have you had any property claims in the last 5 years?

Yes

No

Claim type

Date

When would you like your new policy to start?

Form Type

Dwelling (A) Coverage

Other Structures (B) Coverage

Loss of Use (D) Coverage

Personal Liability (E) Coverage

Medical Payments (F) Coverage

All Other Perils

Hurricane

Wind / Hail

Inc. Ordinance or Law

Yes

No

OTHER COVERAGE

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Text: (919) 797-0135

Fax: (919) 338-7652

Call: (919) 797-0135

Working hours

Monday: 8:30 am - 6 pm

Tuesday: 8.30 am - 6 pm

Wednesday: 8.30 am - 6 pm

Thursday: 8.30 am - 6 pm

Friday: 8.30 am - 6 pm

Sat - 8.30 am - 3 pm

Sun: Off

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Salazar Insurance Agency
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