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 Name Last Name Date of Birth
Co-Applicant

First Name Last Name Date of Birth
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Is this also the Mailing Address?

Yes No
Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number
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?

Yes No
Pool Area Screened?

Yes No
Is the yard Fenced?

Yes No
Trampoline?

Yes No
Aggressive Dog?

Yes No
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.

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