Insurance Agency - O'Fallon IL - Mueller Schneidewind Koeneman Agency

Home Insurance Questionnaire

Contact Us

DATE

Free Text

HOMEOWNERS QUESTIONS

Name

PHONE NUMBER

Who is on the Deed

EMAIL ADDRESS

1. Property address

2. In or outside city limits-

If outside, who is responding fire dept. & how far out of town

Are they within 1,000 feet of fire hydrant

3. How many acres or 1 lot

What County

4. Year Built

Square Footage

Free Text

Circle which it has (Fire Ext, Smoke Detectors, Deadbolts, Central Alarm

A. How may Stories

Bi-Level

Tri-Level

6. Basement (finished or unfinished, walkout) or crawlspace or slab

A. If finished basement, need %

7. Frame or brick construction

If both, what is the % of each

Free Text

If Frame, is it VINYL, ALUMINUM, WOOD, ASBESTOS SIDED

8. Type of Roof

Free Text

A. ( Homes over 25 years old) need dates of renovation of wiring,\ roof, \ heating, \ plumbing)

A. (Homes over 25 years old) need dates of renovation of wiring,\ roof, \ heating, \ plumbing)

9. Are there any Bay windows?

Picture windows?

Are there any Bow windows?

Skylights?

Are there Sliding Glass Doors

How Many

Are there any French Doors?

(# of doors) Solar panels?

10. What are the walls & ceilings made of: (Drywall) (Plaster)

What percentage of the walls paint

What percentage of the walls wallpaper

What percentage of the walls paneling

What percentage of the walls ceramic tile

11. Air Conditioning (central or window unit)

A. How is it heated

12. What % of the floor is wall to wall carpet

% Carpet over Hardwood

What % of the floor is hardwood

% Parquet/Laminate

What % of the floor is ceramic tile

What % of the floor is vinyl

Free Text

13. SMOKER OR NON SMOKER HUSBAND

New Field:

WIFE

14. Garage (attached or detached) 1 or 2 car

A. Any other outside structures---

Free Text

(Fence, Pool (Above/Below), Shed, Barns, etc and values)

B. Any swimming pools? Is it fenced and locking gate?

Diving board or slide?

15. Fireplace (wood or gas) or wood burning stove

If wood burner, where is it located

Any Free Standing Fireplace?

UL approved?

16. Porch (open or enclosed) & sq. ft.

17. Deck? Sq.ft

Any Trampolines?

Caged and anchored?

18. How many bathrooms (full, 1/2 or 3/4)

19. Any dogs--what breed are they and how controlled?

20. Is this a new purchase, what is the date of closing?

What was your prior address if within 2 years

Year purchased?

A. What is the purchase price?

B. Already insured? (Current Company, Current Coverage & Ded Amt)

C. List all claims or losses for the past five years? If so, what & when and for how much paid by insurance company.

D. Have you ever been cancelled/non-renewed?

21. Is this home used for home daycare?

22. Do you own any recreational vehicles ie. Boats, ATV, Scooters

If so where are they covered for liability?

B. Earthquake or mine subsidence?

C. Do you want water backup or sewer coverage-- (5,000) (10,000) (25,000) Battery backup?

D. What are the Liability Limits needed:

100,000

300,000

500,000

E. What are the Medical Limits needed:

1,000

2,000

5,000

10,000

23. What are the electrical Amps?

Free Text

SOME OF THE COMPANIES RUN CREDIT – MUST GET APPROVAL

NEED DATE OF BIRTHS FOR HUSBAND

WIFE

Contact Us

DATE

Free Text

HOMEOWNERS QUESTIONS

Name

PHONE NUMBER

Who is on the Deed

EMAIL ADDRESS

1. Property address

2. In or outside city limits-

If outside, who is responding fire dept. & how far out of town

Are they within 1,000 feet of fire hydrant

3. How many acres or 1 lot

What County

4. Year Built

Square Footage

Free Text

Circle which it has (Fire Ext, Smoke Detectors, Deadbolts, Central Alarm

A. How may Stories

Bi-Level

Tri-Level

6. Basement (finished or unfinished, walkout) or crawlspace or slab

A. If finished basement, need %

7. Frame or brick construction

If both, what is the % of each

Free Text

If Frame, is it VINYL, ALUMINUM, WOOD, ASBESTOS SIDED

8. Type of Roof

Free Text

A. ( Homes over 25 years old) need dates of renovation of wiring,\ roof, \ heating, \ plumbing)

A. (Homes over 25 years old) need dates of renovation of wiring,\ roof, \ heating, \ plumbing)

9. Are there any Bay windows?

Picture windows?

Are there any Bow windows?

Skylights?

Are there Sliding Glass Doors

How Many

Are there any French Doors?

(# of doors) Solar panels?

10. What are the walls & ceilings made of: (Drywall) (Plaster)

What percentage of the walls paint

What percentage of the walls wallpaper

What percentage of the walls paneling

What percentage of the walls ceramic tile

11. Air Conditioning (central or window unit)

A. How is it heated

12. What % of the floor is wall to wall carpet

% Carpet over Hardwood

What % of the floor is hardwood

% Parquet/Laminate

What % of the floor is ceramic tile

What % of the floor is vinyl

Free Text

13. SMOKER OR NON SMOKER HUSBAND

New Field:

WIFE

14. Garage (attached or detached) 1 or 2 car

A. Any other outside structures---

Free Text

(Fence, Pool (Above/Below), Shed, Barns, etc and values)

B. Any swimming pools? Is it fenced and locking gate?

Diving board or slide?

15. Fireplace (wood or gas) or wood burning stove

If wood burner, where is it located

Any Free Standing Fireplace?

UL approved?

16. Porch (open or enclosed) & sq. ft.

17. Deck? Sq.ft

Any Trampolines?

Caged and anchored?

18. How many bathrooms (full, 1/2 or 3/4)

19. Any dogs--what breed are they and how controlled?

20. Is this a new purchase, what is the date of closing?

What was your prior address if within 2 years

Year purchased?

A. What is the purchase price?

B. Already insured? (Current Company, Current Coverage & Ded Amt)

C. List all claims or losses for the past five years? If so, what & when and for how much paid by insurance company.

D. Have you ever been cancelled/non-renewed?

21. Is this home used for home daycare?

22. Do you own any recreational vehicles ie. Boats, ATV, Scooters

If so where are they covered for liability?

B. Earthquake or mine subsidence?

C. Do you want water backup or sewer coverage-- (5,000) (10,000) (25,000) Battery backup?

D. What are the Liability Limits needed:

100,000

300,000

500,000

E. What are the Medical Limits needed:

1,000

2,000

5,000

10,000

23. What are the electrical Amps?

Free Text

SOME OF THE COMPANIES RUN CREDIT – MUST GET APPROVAL

NEED DATE OF BIRTHS FOR HUSBAND

WIFE

Our office is located at:
500 Southview Plaza, Suite 17
O'Fallon, IL 62269-2688

Our phone number is 618-624-5441
Our fax number is (618) 624-5445

Email Address:
[email protected]
[email protected]

Call to speak with an agent for free, no-obligation insurance quotes.

BROWSE OUR WEBSITE

CONTACT INFORMATION

PHONE:

618-624-5441

EMAIL 1:

[email protected]

EMAIL 2:

[email protected]

OUR LOCATION

ADDRESS:

500 Southview Plz #17 O'Fallon, IL 62269

Business Hours:

Mon - Fri: 9:00 am - 5:00 pm
Sat - Sun: Closed