Homeowners Insurance Application

Current Homeowners Insurance Information

More information may be needed.  If so, a representative from Crosswinds Insurance Agency will contact you to discuss.

As part of the application process in obtaining the insurance coverage you are requesting from licensed insurance carriers of Crosswinds Insurance Agency, LLC and/or it’s licensed carriers may order one or more consumer reports.

A consumer report may contain information on credit history, medical conditions, driving records, criminal activity and hazardous sports, among other things.

Under the Fair Credit Reporting Act, Crosswinds Insurance Agency, LLC and/or it’s licensed carriers may review consumer reports to evaluate anyone who applies for this insurance. In the event that coverage is denied to you based wholly or partly on information in a consumer report you will be notified of this fact and given the name and address of the consumer reporting agency making the report.

It is understood and agreed that the completion of this application shall not be binding either to the proposed insured or to the Company until accepted by the Company or Companies but that the information contained herein shall be the basis of the contract should a policy be issued.


I/We understand and agree that any misstatement of warranty or fact on this application shall be considered a violation of coverage afforded under any policy issued on the basis of this application. I/We understand and agree that this application shall form part of any policy issued.

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