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Are you currently insured?
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Insurance Type?
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Homeowners - I own and need content coverage
Condo - I own but only need content coverage
Townhome - I own but only need content coverage
Landlord - I own but house rented to another party
Approximate Year Built?
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2010 - This Year
2006-2010
2001-2005
1991-2000
1981-1990
1971-1981
1961-1970
1951-1960
1941-1950
1931-1940
1921-1930
1911-1920
1901-1910
1891-1900
1881-1890
1871-1880
1861-1870
1851-1860
1850 or Earlier
Property Type
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Single Family Home
Apartment
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Manufactured/Mobile Home
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Construction Type?
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Mostly Brick
Mostly Wood Frame
Stucco
Unsure
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Roof Type?
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Asphalt Shingle
Wood Shingle
Tile
Number of Stories?
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1
1.5
2
3
4 or More Stories
Bi-Level
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Number of Bedrooms?
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One
Two
Three
Four
Five
Six
Seven
Eight or More
Number of Bathrooms?
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1
1.5
2
2.5
3
3.5
4+
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Garage Type?
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Attached - 1 Car
Attached - 2 Car
Attached - 3 Car
Attached Carport
Detached - 1 Car
Detached - 2 Car
Detached - 3 Car
Detached Carport
No Garage
Other
Foundation Type?
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Basement Fully Finished
Basement Half Finished
Basement Unfinished
Crawlspace
Slab
Unsure
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Approximate Square Footage?
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Less Than 500 SF
501-750 SF
751-1,000 SF
1,001-1,250 SF
1,251-1,500 SF
1,750-2,000 SF
2,001-2,250 SF
2,251-2,500 SF
2,750-3,000 SF
3,001-3,250 SF
3,251-3,500 SF
3,750-4,000 SF
4,001-4,250 SF
4,251-4,500 SF
4,750-5,000 SF
5,001-5,250 SF
5,251-5,500 SF
5,750-6,000 SF
6,001-6,250 SF
6,251-6,500 SF
6,750-7,000 SF
7,001-7,250 SF
7,251-7,500 SF
7,750-8,000 SF
8,001-8,250 SF
8,251-8,500 SF
8,750-9,000 SF
9,001-9,250 SF
9,251-9,500 SF
9,750-10,000 SF
More than 10,000 SF
Primary Heating System?
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Gas (forced air)
Electric
Hot Water/Steam Radiate
Oil/Coal/Kerosene
Propane
Stove
Unsure
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Fire Alarm?
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None
Monitored
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Security System?
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Monitored
Unmonitored
Unsure
Municipal Location?
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Inside City Limits
Outside City Limits
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List Potential Discounts?
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None
Deadbolts
Smoke Alarms
Fire Extinguishers
Nearby Fire Hydrant
Manned Fire Station within 5 Miles
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Add-ons or Improvements?
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None
Sump Pump
Sauna
Hot Tub
Covered Deck/Patio
Wood Burning Stove
Central Air Conditioning
In-Ground Swimming Pool (not fenced)
In-Ground Swimming Pool (fenced)
Deductible?
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1 Percent
2 Percent
$100
$250
$500
$1000 (most common)
$2,500
Liability Protection?
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$100,000
$300,000 (most common)
$500,000
$1,000,000 (umbrella liability)
$2,000,000 (umbrella liability)
List Any Past Claims
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None
Weather
Theft
Vandalism
Water
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Full Name
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First Name
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E-mail
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