Thank you for choosing Coastal Insurance. We will work diligently to find you the most adequate and cost effective coverage for your south Florida home. Simply complete the form below and a luxury home insurance specialist will be in touch with you soon. You may also call us at (850) 231-0042 or email us directly at


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Miami Home FORM

We would love to hear from you!
Please complete this simple form and we will get in touch with you soon regarding your specific insurance needs.


Client information: This information is used solely for the purpose
of obtaining an insurance proposal and is kept confidential.

Name: *
Property Address: *
Property Address:
Date(s) of birth for all deeded owners: *
Date(s) of birth for all deeded owners:
If your home is owned by an LLC or trust, please provide the date(s) of birth for the principles and/or managers of the entity.
Primary Telephone Number: *
Primary Telephone Number:
Alternative Telephone Number:
Alternative Telephone Number:
Do you have an active flood policy: *
Do you have jewelry or collectible items that you want to schedule: *
Also called additional living expense or loss of rental income
Do you live in a community with an HOA: *
Gated Community: *
Monitored Burglar Alarm: *
Monitored Fire Alarm: *
Fire Sprinklers: *

You may also fax a copy of your current declarations page(s) to our office at (850) 837-1014 or email them to While a declarations page is not required, it gives our specialists the opportunity to thoroughly review your policies and determine how we can better assist you. 

This information is not an offer to sell insurance. Insurance coverage cannot be bound or changed via submission of this online form/application, e-mail, voice mail or facsimile. All coverages are subject to the terms, conditions and exclusions of the actual policy issued. Not all policies or coverages are available in every state.