Homeowners Quote Information
Client Information
Names: 1.
2.
Address to be Insured:
City:
State:
County:
Zip Code:
Date of Birth 1:
2:
SSN: 1:
2:
Mailing Address (if different):
Email:
H:
W:
C:
F:
General Home Information
Home is Occupied by:
Owner
Tenant
Secondary
Seasonal
Other:
Purchase Date:
Year Built:
Total Sqft:
Style:
Stories:
No of Families:
Foundation:
Basement:
Parital
Full
%
Is it a Daylight/Walkout?
No
Yes
Finished:
No
Yes
If yes:
% finished
Exterior Walls:
Roofing Material:
Closest Fire Hydrant:
# of ft /
Fire Dept:
# of mi.
Garage:
# of cars
Attached
Detached
Built-in (finished room over)
Deck:
sqft
Patio:
sqft
Porch:
sqft
Sunroom:
sqft
Interior Walls:
Drywall
Plaster
Wood
Other
Bathrooms:
# of Full /
# of Half
Interior Finish:
Paint
Wood Paneling
Brick Facing
Other
Fireplaces:
# of fireplaces /
# of chimneys
Type of Heating system:
Type of Fuel:
Natural Gas
Propane
Electric
Other
Central Air in home:
No
Yes
If Yes:
Same ducts as heat
Separate Ducts
Floor coverings (please indicate % of each type):
Do you have any of the following features in your home
Island in Kitchen
Separate Cook-top & Oven
Built-in Microwave
Separate Tub & Shower
Jacuzzi tub
Sauna
Wet Bar
Intercom
Atrium Door
Atrium Window
Bay Window
Bow Window
Picture Window
Sliding Glass Door
French Doors
Solar Panels
Central Burglar
Central Fire
Central Vacuum
Hot tub
Pool: In ground / Above Fiberglass / Concrete
Trampoline
Granite/Corian/Stone Countertops
Other:
Notes: