LSIG - Homeowner's Punch List

LONE STAR INSURANCE GROUP
P: (936)449-6547 F: (936)449-6447 E: SERVICE@LONESTARINS.NET

HOME AUTO COMMERCIAL MOTORCYCLE BOAT MOBILE HOME RV's
1 Title Holders Names
2 Address of Property
3 Mailing Address
4 Email Address
example@example.com
5. Phone Number
6 SSN
7 Date of Birth

MonthDayYear
Date
8 Tx DL Number
9 Current Carrier
10 Current Policy Expiration Date

MonthDayYear
Date
11. Is this a mobile home?

YesNo
11a. If yes, is it in a mobile home community?

YesNo
11b. Is it fully skirted?

YesNo
11c. Tied Down?

YesNo
12 Is this the primary residence?
13 Year built
14 Composition of home
15 Composition of roof
16 Year roof last updated

MonthDayYear
Date
17 Year electrical last updated

MonthDayYear
Date
18 Year plumbing last updated

MonthDayYear
Date
19 Square Feet
20 How Many Stories?
21 Is there a woodburning fireplace?

YesNo
21a. If Yes, how many?
22 Is there a pool?

YesNo
22a. If yes Is there a slide or diving board?

YesNo
22b. Is it fenced in?

YesNo
23 Garage attached or detached?
23a. How many cars garage?
24 Value of property to insure
25 Lien holder Mortgage Company name and address
26 If this is a new purchase please provide your previous address
27 How did you hear about us?
Should be Empty:

LONE STAR INSURANCE GROUP