Lori Zucco Ins. Homeowners Form

Lori Zucco Ins. Homeowners Form

Please complete the form accurately for better assistance. Feel free to call if you have any questions or problems. 205-942-4448
Applicant

First NameLast NameDate of Birth
Co-Applicant

First NameLast NameDate of Birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is this also the Mailing Address?
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Current Insurance Carrier, Time With Carrier, Coverage Amounts
Ex. Travelers Insurance from 2018 $250,000 in Property Coverage and $300,000 in Liability .
Number of Bedrooms
Number of Baths
Pool?
Pool Area Screened?
Is the yard Fenced?
Trampoline?
Aggressive Dog?
Roof Type
Please Describe
Age of Roof
Garage (# of Cars)
Enter 0 if no Garage...
Floor types
Please list all flooring types (Tile/Carpet/Laminate/etc.)
Percentage of each flooring type?
What% of each flooring type? (Example 70% Tile 30% Carpet)
Updates to Electrical, Plumbing, or A/C?
Please list and provide approx month/year of update for each.
Claims in last 5 years?
Describe what type and how much was paid
Information Agent can get from County Website
Year Built
Home Sq. Ft.
Pool Sq. Ft.
Patio Sq. Ft.
Porch Sq. Ft.