Company Name (not agency):
Policy Expiration Date(MM/DD/YYYY):
Amount Insured For ($):
Premium Amount ($):
Mortgage Amount ($):
1 Year2 Year3 Year4 YearMore Than 4 Years
Any Claims In Last 3 Years:
No Claim1 Claim2 ClaimMore Than 2 Claims
Year Home Built In:
Number Of Storeys:
$100,000$200,000$300,000$500,000$1,000,000More than $1 million
Total Area (Sq.Ft):
Number Of Years At Present Address:
Market Value ($):
Number Of Garage:
Number Of Bedrooms:
Number Of Bathrooms:
Number Of Fireplaces:
Distance to Nearest Fire Department:
Less than 5 milesMore than 5 miles
If Yes, What Percentage (%):
List Pets & Breeds:
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We don’t simply view ourselves as a business in a particular community. We view ourselves as a vital part of the community, helping to protect families and businesses that make the community what it is.
GYC Insurance Agency LIC#0f88072
2901 West Coast Hwy, Suite 200,
Newport Beach, CA 92663.
(714) 375-3894(714) 375-3894