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Named Insured
Second Named Insured
Dwelling Information
Interior Features
Stories ---11.523 Cathedral Ceilings Foundation ---BasementCrawlspaceConcrete SlabOther If you have a basement foundation, what percent of it is finished? Garage ---AttachedDetachedBasementNone Number of Cars---12345 Kitchen Number of Kitchens---123 Quality of Kitchen(s)---BasicBuilders GradeCustomLuxury Bathroom Number of Full Bathrooms---0123456 Number of Half Bathrooms---0123456 Quality of Bathroom(s)---BasicBuilders GradeCustomLuxury Floors ---HardwoodLaminateTileCarpet ---HardwoodLaminateTileCarpet ---HardwoodLaminateTileCarpet Fireplaces/Wood stoves NoneGas FireplaceElectric FireplaceWood stove If you have a wood stove, was it professionally installed? YesNo If you have a wood stove, does it meet the government guidelines for wall distance? YesNo
Exterior Features
Deck UncoveredCoveredScreened Porch UncoveredCoveredScreened Siding ---BrickVinylStuccoWood ShingleBrick Veneer ---BrickVinylStuccoWood ShingleBrick Veneer ---BrickVinylStuccoWood ShingleBrick Veneer Roof Shingle Type:---AsphaltWood ShakeMetalTileSlate Acreage Other Exterior Features. Check All that Apply. Hot TubPoolTrampolineGazeboShed/OutbuildingSliding Glass DoorFrench DoorSky LightBay WindowSolar Panels
Last Update to: Roof Plumbing Electrical HVAC Scheduled Personal Property JewelryFirearmsSilverwareArtAntiques Mortgagee Information No Mortgagee Current Insurance When does your current policy end? No Current Insurance Coverages Actual Cash ValueReplacement Cost Current Liability Coverage---100,000300,000500,0001,000,000 Are you wanting the same coverages?YesNo If not, please explain: Claims List All Claims in Last 5 Years Please include the date, type of loss, and payout.
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