Skip to content

Falcon West Insurance Applications

Application: Academy
Careers: Falcon West Personal Lines Account Manager Application
File Transfer to Falcon West Energy
File Transfer to Falcon West Insurance
Home Page
Insurance Start
Intake: Boat and Craft
Intake: Business
Intake: Energy Consultants
Intake: Landlord 1-4 Units
Intake: Personal
Intake: Policy Upload
Photo Timestamp Tool
Privacy Policy
Thank You

Falcon West Insurance Applications

Application: Academy
Careers: Falcon West Personal Lines Account Manager Application
File Transfer to Falcon West Energy
File Transfer to Falcon West Insurance
Home Page
Insurance Start
Intake: Boat and Craft
Intake: Business
Intake: Energy Consultants
Intake: Landlord 1-4 Units
Intake: Personal
Intake: Policy Upload
Photo Timestamp Tool
Privacy Policy
Thank You

Step 1 of 18

5%

Personal Insurance Application

This comprehensive insurance application will allow us to shop for your home, condo, or renters insurance coverage across all our carriers, along with auto, umbrella, personal articles, flood, and earthquake.

Before you begin:

We recommend having the VIN for your vehicles, driver's license numbers for all household drivers, and the exact vehicle miles.

Please note that a majority of our carriers require bundling home and auto coverages. Without this information, we may not be able to proceed.

We look forward to working with you!

This field is hidden when viewing the form

Broker Name

This field is hidden when viewing the form

Broker Email

This field is hidden when viewing the form

Client Name

First Last

This field is hidden when viewing the form

Client Phone

This field is hidden when viewing the form

Client Email

This field is hidden when viewing the form

Need By / Effective Date

MM slash DD slash YYYY

What type of home coverage do you need?

How did you hear about us?

What is your current carrier?

Type of rental unit:

Address to insure:

Street Address City State ZIP Code

Is this for a new home purchase?

What address are you moving from?

Street Address City State ZIP Code

Is there a mortgage or lienholder on the home?

Is your home titled in a Trust or LLC?

Trust or LLC Name

If you have this close by, we can collect it now.

Do you have a separate mailing address?

Household + Dependants

Name

First Last

Date of Birth

MM slash DD slash YYYY

Driver's License Number

Employer

Occupation

Home Details

What year was the home built?

Home Square Feet

How many stories?

How many bedrooms?

How many bathrooms?

How many fireplaces and/or wood burning stoves?

How many garage spaces?

Quality of Fixtures and Finishes

Do you know the construction type?

Do you know the roofing type?

Do you know the foundation type?

Is there a basement?

Do you have dogs?

Breed(s), and any bite history?

Do you have a pool?

Do you have a trampoline?

How close is the nearest fire station?

How close is the nearest fire hydrant?

Does the home have Interior Fire Sprinklers?

Does the home have an Exterior Fire System?

Does the home have a fire alarm?

Does the home have a burglar alarm?

Does the home have a Water Flow Device?

Does the home have an Earthquake Gas Shutoff?

Master HOA Insurance Policy

The Master HOA Insurance policy provides important information related to your individual condo coverage. If you do not have a copy, you can request one from the HOA or your real estate agent.

Are you responsible for the entire construction of the condo (inside and out), or only for the construction “walls in”:

What is the current HOA Loss Assessment Deductible:

Personal Property

Personal property coverage — also known as contents coverage on a home policy — helps cover the cost of your personal items if they are destroyed, damaged, or stolen due to a covered loss or peril. Personal property includes things like furniture, clothing, electronics, and kitchenware.

Personal Property Value

Custom Amount

Property Updates

Insurance carriers are requesting more information about property updates, particularly on homes built 15 or more years ago.

Roof Updates

None

Partial

Complete

Roofing Update Year and Details

Electrical Updates

None

Partial

Complete

Electrical Update Year and Details

Plumbing Updates

None

Partial

Complete

Plumbing Update Year and Details

HVAC Updates

None

Partial

Complete

HVAC Update Year and Details

Water Heater Updates

None

Partial

Complete

Water Heater Update Year and Details

Have you had a policy cancelled by an insurance company in the last 5 years?

Have you had any residential insurance claims in the last 5 years?

Briefly describe the claim(s):

Now, let's gather some information about your vehicles for auto coverage. Please note that most of our carriers require bundling home and auto coverage. Without this information, we may not be able to proceed.

Vehicle 1

VIN

17 Digits

Year

Make

Model

Exact Odometer Reading

How many miles is this vehicle driven per year?

Does this vehicle have an active antitheft device installed like LoJack or KARR?

Commuting habits:

Have any drivers had any auto claims or tickets?

Do you have any unlicensed or recreational vehicles like Watercraft, Tractors, Golf Carts, or ATV?

Do you have any electric bikes or scooters in your household?

Do you have any personal articles to insure like Art, Jewelry, or Collections?

Do you currently have an umbrella policy?

What limit of umbrella coverage do you want?

Does anyone in the household serve as a board member, director, or officer?

Discount Opportunities

Let us know if any of these apply to your household. Verification may be required by the carrier.

Gated Community

New Purchase

Military (Active or Retired)

School Teacher / Educator

Costco, Sam's Club, or AAA Member

Home deductible up to:

Auto deductible up to:

Name

First Last

Δ

Copyright © 2026 Falcon West Insurance Brokers, Inc. | Privacy Policy

5353 Mission Center Road, Suite 215, San Diego, CA 92108 | CA Lic# 0616640

Scroll to Top