Use of Home
Name as listed on deed*
Property Address
Phone Number*
Email*
If unsure of replacement cost of dwelling, please complete part 2.
Replacement cost of dwelling
Deductible
Liability
Year Built
Construction
Roof material
Number of Stories
Sq Ft
Heat Source
Pool
Animals/Pets
Has coverage been cancelled or declined?
Have there been any claims or losses in the last 5 years?
Smoke Detectors
Security Guard
Fire Extinguishers
Interior Sprinkler System
Deadbolt Locks
HOA
Central Station Alarm
Auto
Umbrella Liability
Earthquake
Scheduled Items
Boats
Golf Cart
Flood
Total Living Area (Sq Ft)
Garage/Carport # of cars
Foundation
Kitchen
Baths
Screened/enclosed porch (Sq Ft)
Open Porch (Sq Ft)
Deck (Sq Ft)
Fireplace