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Glossary
Request
A Homeowners Quote
Name:
E-mail:
Phone Number:
Address:
City:
State:
Zip:
County:
Date Of Birth
/
/
DD/MM/YYYY
SSN
-
-
Occupation
Have You Ever Been Convicted Of A Felony?
NO
YES
Married Of Single?
Married
Single
If MARRIED
Spouse Date Of Birth
/
/
DD/MM/YYYY
Spouse SSN
-
-
Spouse Occupation
First Time Homeowner?
NO
YES
Purchase Price
Prior Coverage:
NO
YES
IF YES
Previous Carrier:
Total Square Footage UPSTAIRS:
Total Square Footage DOWNSTAIRS:
Year Built:
Number of Stories:
1
1 1/2
2
2 1/2
3
3 1/2
Above Ground?:
NO
YES
Geometric Shape:
Bi-Level
Split Level
Ranch Style
Basement:
NO
YES
IF YES
Full
Garden
Walkout
Percent Finished
Frame Or Masonry
Frame
Masonry
Garage
NO
YES
IF YES
One Car
Two Car
Three Car
Attached
Detached
Carport
Deck/Porch/Breezeway
Deck
Porch
Breezeway
Covered?
NO
YES
Material
Square Footage
Roof Construction Type
Siding Type
Flat Roof
NO
YES
Update Years
Roof
Electrical
Plumbing
Heating
Any Remodeling
NO
YES
IF YES
Basic
Average
Upgraded
Type Of Heat
Gas Forced Air
Electrical
Other
Supplemental Heat
Woodburning Stove
Fireplace
Gas Insert
Pellet
Deadbolt Locks
NO
YES
Fire Extinguisher
NO
YES
Smoke Detector
NO
YES
Security System
NO
YES
Trampoline
YES
NO
Fenced
YES
NO
Pool
YES
NO
Fenced
YES
NO
Hot Tub
YES
NO
Fenced
YES
NO
Lock
YES
NO
Exotic Animals
NO
YES
IF YES
Describe Animals
Day Care On Premises
NO
YES
Bankruptcy
NO
YES
Dog
NO
YES
IF YES
What Kind
Number of Occupants
Any Prior Losses
Previous Address
City:
State:
Zip:
Coverage On Policy
Dwelling
Other Structures
Personal Property
Loss of Use
Personal Liability
Medical Payments
Deductible
