ABOUT YOUR PROPERTY
Year Built:		Size (in sq feet):
Year Purchased:
Number of Bedrooms:	1 2 3 4 5 6 7 8        Bathrooms  1 1.25 1.5 1.75 2 2.25 2.5 2.75 3 3.25 3.5 3.75 4    Garages 0 1 2 3 4 5 6 7 8
Stories:	0 1 2 3 4
Structure Coverage:	$ If you  do not know he amount of coverage that you require, we will use our rebuilding cost estimator for the initial quote.  We quote REPLACEMENT COST coverage or EXTENDED REPLACEMENT COST coverage (when available).  If you would prefer an actual cash value quote, which has depreciation, please let us know in the comment box below.
Roof Type:	Tiles CHOOSE ONE Asphalt Composite Wood Shingles Not Sure What Type
Age of Roof:	MUST CHOOSE ONE YES - my roof is less than 25 years old NO - my roof is more than 25 years old
Usage:	CHOOSE Owner Occupied Owner - Secondary Home Owner - Seasonal Use Tenant Occupied Vacant
Attached:	Detached Home Attached on One Wall, but with no homeowners association Part of a Condo/Townhouse
Liability Limits:	$100k $300k$500k If you need more liability insurance, we can obtain an umbrella policy quote from $500,000 to $5 million.
Personal Property Coverage:	$ (coverage for fixtures, furniture, appliances, and other personal property.  We will add $10,000 if this is left blank and you may alter the quote later )
Other:	Do you have a pet?   If yes, choose amount of animal coverage: No Coverage $25,000 $50,000 $100,000 $300,000
	Prior losses or claims? Woodburning Stove
	Swimming Pool?           Trampoline?
Electrical:	Circuit Breakers Fuses CHOOSE ONE
	Is the dwelling within 500 feet of native brush, or isolated or inaccessible to fire fighting equipment? Yes     No
	Do you currently have insurance (if yes, with what carrier?
	What is your current yearly or monthly premium?
	Do you have any other information about your property or apartment, or comments that you would like to share? Please place special requests here, such as extra coverage for special items.
NO COVERAGE IS BOUND, OFFERED, ISSUED THROUGH THIS ELECTRONIC COMMUNICATION, ALL POLICIES MUST BE UNDERWRITTEN AND APPROVED BY THE CARRIER. DO NOT CANCEL YOUR CURRENT INSURANCE.