Personal & Property Information
Name:
*
*
Property Address:
*
*
*
*
Phone:
*
Email:
*
Property Details
How would you describe this home?
*
Select
Primary home
Seasonal home
Secondary Home
Rental property
Vacant
Do You currently live at this property?
*
Yes
No
Do You currently a have Homeowner insurance policy?
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Yes
No
Are there any dogs on your property?
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Yes
No
Have you had a claim or loss at any residence during the past five years?
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Yes
No
Approximate Date of Loss:
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Briefly Describe the Loss:
*
Additional Property Information
Approximate Year Built:
Number of Stories:
Approximate living are (sq.Ft):
Construction Type
Select
Frame
Veneer
Masonry
Superior
Roof Type
Select
Tile
Slate
Metal
Wood shake
Other
Distance from fire station
Select
5 miles or less
Over 5 miles
Does this property have a pool or spa?
Yes
No
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