Personal Home Owners Quote

Contact Information

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

AMOUNT OF ROOMS:

1st Floor:   

2nd Floor:  

3rd Floor:   

List Rooms (Living rm., Dining Rm., etc):

Square Footage of 1st Floor:      

Total Square Footage of House: 

Is the basement finished?:

                Yes
                No

If so how many finished rooms?: 

Fireplaces: 

Where located:

Garage attached or built-in to house:

                Yes
                No

Central air:

                Yes
                No

How is the home heated?: 

Full Baths: 

Half baths: 

Any baths connected to bedroom:

                Yes
                No

Any deck:

                Yes
                No

Any porches:

                Yes
                No

What kind of porch:  Open Closed

CHECK THE FOLLOWING THAT APPLY:

Ceiling Fans:   Intercom System: Alarm: Local Central   

Central Vacuum System: Water Softener:

Built-in Refrigerator: Hot Tub (Not Jetted):

Jetted Tub: Sauna: Wet Bar:

Sky Light: Wood-Burning Stove:

Counter Top Range:

What style of house is it? Colonial Ranch Bi-Level

Is the home a custom? 

        Yes
        No

How many corners on the house?

List any Specialty Rooms (eg. Den, Rec. Room, Exercise Room, etc.):

House Structure:  Frame Alum. Siding Brick

Year house was built?

Full Proper Names:

Date of Births of Insured:

Mortgagee:

Lawyer Name and Telephone:

Date of Closing:

Occupation:

Social Security Numbers: ,

If New Home, the dates of updates of the following must be supplied:

Electricity: Plumbing:

Wiring: Roofing:

Exterior Paint:

Prior Career:

Losses in the past 3 years:

Money Paid Out: