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Home Owner's Quotation Request
Telephone number:
Married, single, widowed, divorced?
If <3 yrs. Previous address
How long at current address?
Is the garage attached or detached from the home?
Purchase date of the home?
Market value?
1st occupant date of birth?
1st occupant Soc. Sec. number?
Spouses Soc. Sec. number?
Spouses date of birth?
Next renewal date?
Prior insurance?
How many losses in last 3 yrs?
How long with current carrier?
Policy number?
Year house was built/ age?
Describe each loss.
(List dates).
Total square feet in house?
(Living Area)
Is home built on?
 (slab, crawl space,basement)
How many car garage?
(1 car, 2 car, 3 car, or none)
Single family/Multi family dwelling?
How many stories?
(1 story, 2 story, etc.)
How many baths?
Are they 1/2, Full or 3/4 baths?
Would you describe your kitchen as 
(basic, average, semi-cust., custom or designer?)
Is there a carport? If yes ,how many cars?
Are there any outside shed/storage buildings?
What size sheds are they?
(8x16, 20x40, 30x50,or none.)
Total number of fireplaces?
Any additional "wood burning" stoves?
Is there a swimming pool?
Above ground or below ground?
Fenced? (yes, no)
How big is the pool?
Is there a diving board?
Is there a tennis court or Gazebo?
Is there any wood decks or open porches?
(if yes- How big are they?
What is the outside of your house made of?
(frame, brick veneer, block, vinyl siding, metal siding)
What type roof does your home have?
(asphalt comp shingle, metal, wood shake, clay tiles, tar and gravel?)
Age of roof? 
What type of heat/air conditioning do you have?
(Central heat and air cond, heating gas, heating electric, wall furnace, Dearborne heaters, evaporative coolers, refrig. window units)
What are the inside walls made of?
(drywall, paneling, plaster)
Are the ceilings 8 ft. or 10 ft?
If home is over 30 years old - 
When was the plumbing updated?
If home is over 30 years old - 
When was the electircal updated?
If home is over 30 years old - 
When was the air conditioning updated?
How do you pay your insurance?
(monthly draft, full, by mail, mortgage co.)
How many dogs do you own?
Type of dog?
Are there any of the following (if yes, which and how many of each?) (Sliding glass door, skylights, french doors, solar panels, bay windows, bow windows, picture windows)
Thank you for your interest!