Homeowner Policy Information

Named Insured:*

Date:

Property Address:*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Is the house within city limits?

YesNo

Distance to nearest fire station:

Year Built:

Year Purchased:

Number of Stories:

Square Footage:

Foundation Type:

Garage:

YesNo

Attached/Detached

AttachedDetached

Number of Stalls:

Composition of Exterior Walls (please circle):

BrickFrameStuccoOther

Please type the 'other' option here:

Roofing Material:

If it has been replaced, what year?

Full

Three Quarter

Half

Have they been updated?

Heating Gas or Electric:

Has the kitchen been updated?

YesNo

Electrical

Plumbing

Heating

Carpet

Wood

Tile

Vinyl

Other

Do you have an open or screened in porch/patio?

Approximate Square Feet:

Are there any other structures (i.e. workshop, second dwelling, dock)?

Do you have a pool and/or spa?

Hot tub?

Do you own a dog?

YesNo

If so, what breed?

Security System:

YesNo

If yes, who is notified:

LocalCentral StationPolice Department

Fire Alarm:

YesNo

If yes, who is notified:

LocalCentral StationPolice Department

In home sprinkler system:

YesNo

Smart Home connected:

YesNo

Is the house financed?

If so, with whom?

Do you have any of the following:

Second MortgageEquity Line of Credit

If so, with whom?

Have there been any non-weather related losses within the past 5 years that have been claimed on your homeowners insurance?

YesNo

If yes, what was the type of loss and date of loss?

Have there been any weather related losses within the past 5 years that have been claimed on your homeowners insurance?

YesNo

If yes, what was the type of loss and date of loss?

Is there anything that is not covered in this questionnaire that may be beneficial for us to know when quoting this property?

Home Info Sheet

PROPERTY DETAILS

Number of Bathrooms:

If the house is over 25 years, when were the following updated?

Type of Flooring:

PROPERTY OR LIABILITY LOSSES

CURRENT COVERAGE