HOMEOWNERS QUOTE SHEET

Full Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Property Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Email

example@example.com

Fax Number

Area Code Phone Number

What year was your home built?

Roof Type? *

Tile Asphalt Shingle Other

Is your home built on a cement slab?

If other, than specify

Roof Shape

Age of Roof

Type of Construction

Type of Roof?

How far is it to your Fire Station?

How far is it to a Fire Hydrant?

30+ old: + Year upgrades were done:

Square feet under air?

Total square feet of home?

Garage (Number of Autos)

Garage (Attached or Detached or Carport)

Detached Structures

Swimming Pool (Yes or No)

If yes, is your pool screened or fenced?

Do you live in a gated community?

If yes, do you have a pass key or a guard?

Do you have a monitored alarm in your home.

If yes, burglar and fire or both?

Do you have a wind inspection?

If yes, we will need a copy. You can call ISPECT: 239-919-4406 OR 941-724-1714 for a copy. You can email the copy to us at: ParlinInsurance.com

Do you have a dog? If yes, how many and what is/are the breed(s)

Is there a HOA?

What is the replacement cost (cost to rebuild) your dwelling.
Make sure you are insuring the home to no less that $125 (basic builders grade) or $180 (if upgraded) per square foot under air. OR the estimated cost new on appraisal.

Replacement Cost for Coverage A (the building itself)

UNDERWRITING QUESTIONS:

Is this a new purchase?

Closing Date

If not a new purchase is there coverage on the dwelling now?

If no coverage now, when did coverage expire?

If yes, what is renewal date?

Have you had any homeowners losses in the last three years?

If yes,

Do you reside in your home ate least 9 months out of the year?

In no, name and telephone number of your home watch service.

Do you rent your home to others when you are not here?

If yes, the number of months rented.

Underwriting: If rented to others. Quote as DP and get the replacement value of the contents. Mail to rrior address.

Replace value of your contents.

Is flood insurance required by a mortgage company?

If yes, we will need a Flood Elevation certificate to quote flood insurance. Unless built prior to flood zones - 1979-Collier Co.

Thank you we will be getting back to you soon.

Do you have any questions?

PARLIN INSURANCE AGENCY