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Year Home Built: |
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| Home Square footage: |
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Flood ZONE NUMBER:
(look on current policy, if any) |
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Flood COMMUNITY NUMBER:
(look on current policy, if any.) |
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| Number of units: |
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| Type foundation: |
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Other
(list in remarks)
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| Type Roof: |
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Tar/Gravel
Spanish Tile
(list in remarks) |
| Number of stories: |
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2
3 |
If more than 1 story, are some
contents on ground floor, contents
ONLY above the first floor? |
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On ground floor
Above first floor only |
| Currently Insured? |
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Yes
No |
| Name of Carrier & how long insured? |
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| Prior Claims? |
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Yes
No |
| Describe claims In detail: |
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| Plumbing type: |
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Copper
Galvanized
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| Circuit Breakers or fuses? |
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Breakers
Fuses |
| # Bedrooms: |
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| # Fireplaces: |
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Special features
(Le., deck, air conditioning, alarm systems, pool, etc.) |
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| Coverages: |
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| Dwelling Cov. ($) |
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| Contents ($) |
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Deductible ($)
($250, $500, $1,000, etc.) |
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| Comments/Remarks: |
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| Send my quotation via: |
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