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Homeowner’s Quote
Homeowner’s Quote
Number of Insured Homeowners:
1
2
Homeowner 1 Information
Name:
Date of Birth:
MM slash DD slash YYYY
Address:
Phone:
Email:
Occupation:
Homeowner 2 Information
Name:
Date of Birth:
MM slash DD slash YYYY
Address:
Phone:
Email:
Occupation:
Home Information
Policy Effective Date:
MM slash DD slash YYYY
Year Built:
MM slash DD slash YYYY
Date purchased:
MM slash DD slash YYYY
Square feet:
# of stories:
Construction type (ie stucco/frame):
Style (ie ranch):
Roof type (ie asphalt/concrete tile):
# Bedrooms:
Foundation (ie slab or basement):
Basement sqft:
# Car garage:
Garage type:
Attached
Built in
Detached
Car port
Sqft:
Patio:
Open
Covered
Enclosed
None
Sqft:
Balcony/deck:
Sqft:
Kitchen type (ie builder grade, custom, designer):
Builder grade
Semi-custom
Custom
Designer
Luxury
Counter top:
Bathroom type (ie builder grade, custom, designer):
Builder grade
Semi-custom
Custom
Designer
Luxury
# Full bath:
# ½ bath:
# ¾ bath:
Cooling:
AC unit
EVAP cooler
Heating:
Gas
Electric
Wall finish: Paint %:
Wallpaper %:
Other:
Flooring: Tile %:
Carpet %:
Wood %:
Other:
Specialty Systems (ie intercom, central vacuum):
Any in home upgrades (ie built-in cabinets/wet bar):
Updates
Roofing Year:
Roofing:
Full update
Partial update
No update
Heating Year:
Heating:
Full update
Partial update
No update
Plumbing Year:
Plumbing:
Full update
Partial update
No update
Plumbing Type:
Galvanized
PVC
Copper
Electric Year:
Electric:
Full update
Partial update
No update
Electric # Amps:
Fireplace:
Electric
Wood burning
None
Woodstove/pellet stove:
Yes
No
Pets
Dog
Cat
Other
Type and breed:
Scheduled items (ie jewelry/art and $ amount):
Home based business:
Yes
No
Type of business:
Specialty doors or windows:
Attached/Detached structures (ie shed):
Pool:
Yes
No
Pool fenced:
Yes
No
Diving board:
Yes
No
Slide:
Yes
No
Jacuzzi/hot tub:
Yes
No
Trampoline:
Yes
No
Skateboard ramp:
Yes
No
Fire extinguisher:
Yes
No
Smoke detectors:
Yes
No
In home sprinkler system:
Yes
No
Dead bolts:
Yes
No
Smart Home:
Yes
No
Solar Panels:
Yes
No
Short Term Rental:
Yes
No
Gated community:
Yes
No
Retirement community:
Yes
No
Alarm system:
Yes
No
Monitoring company:
# feet to fire hydrant:
# miles to closest fire station:
Responding Fire Department:
Fire Department Subscription:
Yes
No
Length of time at current residence:
Prior address if less than 2 years:
Mortgage company:
Loan #:
Prior Insurance Company:
# years with current company:
Liability limit:
Current annual premium:
Deductible:
$500
$1000
$2500
$5000
Any claims in the last 5 years:
Yes
No
Date of loss:
MM slash DD slash YYYY
Claim amount:
Description:
Are you interested in any of the following if available:
Umbrella
Sewer/water backup
Service Line
Equipment breakdown
Life Insurance
Business pursuits
Identity theft
Home day care
Phone
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