Date
Name
Phone
Who is on the Deed
Email
Property address
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
How many acres or 1 lot
What County
Year Built
Square Footage
How may Stories
Bi-Level
Tri-Level
Basement (finished or unfinished, walkout) or crawlspace or slab
If finished basement, need %
Frame or brick construction
If both, what is the % of each
Type of Roof
For homes over 25 years old we need dates of renovation of wiring, roof, heating, & plumbing
Number of Bay windows?
Number of Picture windows?
Number of Bow windows?
Number of Skylights?
Number of Sliding Glass Doors?
Number of French Doors?
Number of Solar panels?
What are the walls & ceilings made of: (Drywall, Plaster, Etc)
What percentage of the walls are painted?
What percentage of the walls have wallpaper?
What percentage of the walls have paneling?
What percentage of the walls have ceramic tile?
Air Conditioning (central, window unit, etc)
How is the home heated?
What percentage of the floor is wall to wall carpet?
What percentage is Carpet over Hardwood?
What percentage of the floor is hardwood?
What percentage is Parquet/Laminate?
What percentage of the floor is ceramic tile?
Does any Resident of the home smoke?
Garage (attached or detached) (1 or 2 car)
Any other outside structures? (Fence, Pool (Above/Below), Shed, Barns, etc and values)
Any swimming pools? Is it fenced and locking gate?
Diving board or slide?
Fireplace (wood or gas) or wood burning stove?
If wood burner, where is it located?
Any Free Standing Fireplace?
UL approved?
Porch (open or enclosed) & sq. ft.
Deck? Sq.ft
Any Trampolines?
Caged and anchored?
How many bathrooms (full, 1/2 or 3/4)
Any dogs--what breed are they and how controlled?
Is this a new purchase, what is the date of closing?
What was your prior address if within 2 years
Year purchased?
What is the purchase price?
Already insured? (Current Company, Current Coverage & Ded Amt)
List all claims or losses for the past five years? If so, what & when and for how much paid by insurance company.
Have you ever been cancelled/non-renewed?
Is this home used for home daycare?
Do you own any recreational vehicles ie. Boats, ATV, Scooters
If so where are they covered for liability?
Earthquake or mine subsidence?
Do you want water backup or sewer coverage-- (5,000) (10,000) (25,000) Battery backup?
What are the electrical Amps?
Date of Birth: Husband
Date of Birth: Wife
