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Policy Holder #1

Name
MM slash DD slash YYYY
Social Security number is not necessary but may secure a better insurance score and therefore a discounted rate.
Address

Policyholder #2

Name
MM slash DD slash YYYY
Social Security number is not necessary but may secure a better insurance score and therefore a discounted rate.
Address

Property

Recent updates to...

Include built-in garages, finished attics, room additions, above garage living area, etc. DO NOT include basements.

Foundation Type
Daylight Basement?
Walkout Basement?

Exterior

Wood/aluminum/vinyl siding, brick/brick veneer, stucco on frame/concrete, etc. Indicate types and percent of wall area.
Asphalt shingles, wood shingles, steel, tile, etc.

Attached Structures
Is the garage attached, built-in, or detached?

Speciality Items
Pool?
Fenced in?
Lock on pool gate?
Slides/Diving boards?
In or above ground?

Interior

(Builders Grade, Custom, Designer)
(Builders Grade, Custom, Designer)
(Builders Grade, Custom, Designer)

HVAC Information
Air Conditioning?

List the % of Drywall, Plaster, and Other materials.
List the % of Paint, Wallpaper, and Other materials.
List the % of Hardwood, Carpet, Vinyl, Ceramic, and other materials.
Specify # of single and # of double, and if they use wood or gas.

Special Built-in Features
Pets?
Please list number of each type of pet (cats, dogs, other) and predominant breed.
Trampoline?
Do you currently have insurance?
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    Include relevant documents here.

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