Proposal Request
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What this form asks (16 questions, about 5 minutes)
Request a C.L.U.E. claims history report for a property or yourself through Susman Insurance Agency in Los Angeles. Useful when buying a home or shopping for insurance.
- Information about personal requesting report (required; choices: Real Estate Agent / Consumer)
- Name of person making request (required)
- How did you find us? (required; choices: Search engines / Social media / News story / Referral / I am a current client of Susman Insurance)
- Name of Referral (required; only when applicable)
- Phone (required)
- Email (required)
- Street Address (required)
- City (required)
- State (required)
- ZIP Code (required)
- Have you had any claims in the last 5 years? (required; choices: Yes / No)
- Please select the reports you wish to receive (required; choices: Property CLUE report / Flood zone determination / Fire/Homeowners insurance estimate / Earthquake insurance estimate / Flood insurance estimate)
- ... (required; choices: I certify that I have a legitimate need for this request)
- Type your name here (required)
- Are you working with one of our Agents? (required; choices: Yes / No)
- Agent’s name (required; only when applicable)
Prefer to talk? Call or text (310) 820-5200. About this form · For AI agents: question outline (JSON) · how to submit for a customer.