Construction Type: Please Select Wood Frame Brick Brick Veneer Fire Resistive Other If other, please specify:
Exterior Finish: Please Select Vinyl Brick Veneer Brick Fire Resistive Other If other, please specify:
Garage Please Select Attached Built-In Detached Number of Cars:
Bath and BedroomsNumber of full bathrooms: * Number of half bathrooms: * Number of bedrooms: *
Square FootageSquare footage of living area: Square footage of basement: Percentage of basement finished:
Electrical Wiring Type: Please Select Copper Aluminum Knob & Tube Panel: Please Select Breakers Fuses Number of Amps: Please Select 60 100 200 Year Updated:
PlumbingType: Please Select Copper Plastic-Abs Plastic-Pex Plastic-Pvc Other If other, please specify: Year Updated:
RoofType: Please Select Asphalt Shingles Steel Tar & Gravel Year Updated:
HeatingType: Please Select Gas Furnace Electrical Hot Water/Steam Heat Pump Other If other, please specify: Year Installed:
Auxiliary HeatingType: Please Select Woodstive Fireplace Fireplace Insert None Other If other, please specify: Year Installed:
Do you have any claims in the past 6 years? Yes No* If yes, please provide details including date and payout:
Is there a mortgage? Yes No if yes, what bank?