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Homeowners Questionnaire
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DOB
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Location Address (Street, City, State, Zip Code, County)
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Mailing Address (Street, City, State, Zip Code, County)
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Current Insurance Co.
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Current Coverage on Dwelling
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Current Deductible
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Year Built
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Purchase Price
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Roof Type (Asphalt, Shake, Tile, Flat, Rubber, Other)
(optional)
Const. Type (Frame, Brick, Brick Veneer)
(optional)
Siding Type
(optional)
Is there any Stucco?
(optional)
House Type (1 story, 1 1/2 story, 2 story, 2 1/2 story, bi-level, split level)
(optional)
Finished sq. footage (excluding basement)
(optional)
Baths (# of Full, # of 1/2, # of 3/4)
(optional)
Flooring (% Wood, % Carpet, % Tile, % Vinyl)
(optional)
Garage (Attached, Detached, Tuck Under, None)
(optional)
Garage (# of Cars)
(optional)
Deck sq. footage
(optional)
Porch (Open or Closed)
(optional)
Porch sq. footage
(optional)
Basement (Slab, Crawl, Etc.)
(optional)
Basement finished sq. footage
(optional)
Basement Walkout (Yes or No)
(optional)
Central Air (Yes or No)
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Year of Updates (Roof, Plumbing, Heating, Electric)
(optional)
Do you currently have a personal umbrella policy? (Y/N, Limit, UM)
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Any losses in the last 5 years?
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Deductible Options to quote ($1,000, $1,500, $2,500, $5,000, $10,000)
(optional)
Misc.
Hot Tub
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Sauna
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Trampoline
(optional)
Other Structures
(optional)
Sump Pump
(optional)
Const. Category (Builders Grade, Semi-Custom, Custom, Designer)
(optional)
Central Alarm
(optional)
Burglar Alarm
(optional)
Fire Alarm
(optional)
Miles to the Fire Dept.
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Responding Fire Dept. name
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Feet from fire hydrant
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Wood burning stove
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Fireplaces (How many? Gas or Wood?)
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Pets (Type, Breed)
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Swimming Pool
Do you have a swimming pool?
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In ground?
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Above ground?
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Diving board?
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Depth under diving board
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Slide?
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Fully fenced?
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Inland Marine
Jewelry
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Furs
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Fine Arts
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Collectibles
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Silverware
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Guns
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Musical Instruments
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