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Homeowners Insurance Questionnaire
Homeowners Insurance Information
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First & Last Names
*
Your answer
Address:
*
Your answer
Phone Number
Your answer
Who is your Insurance through currently?
Your answer
When does your current policy expire?
Your answer
What is your expiring premium?
Your answer
How much is your home currently insured for?
Your answer
What year was your house built?
Your answer
What year did you move into your home?
Your answer
Construction
Frame
Brick
Other:
Clear selection
What type of siding do you have?
Vinyl
Aluminum
Wood
Multiple/Mix
Other:
Clear selection
How many stories is your home?
1
1.5
2
2.5
3
Other:
Clear selection
What is the square footage of your home, not including your basement?
Your answer
Does your Home have a basement?
Yes
No
Clear selection
What Percentage of your basement is finished?
Your answer
Is it a walk-out basement?
Yes
No
Clear selection
What type of Garage do you have?
Attached
Detatched
Built-In Garage
No Garage
Clear selection
What # of stalls is your garage?
1
1.5
2
2.5
3
Other:
Clear selection
Any other detached structures?
Shed
Pole Barn
Pool/Hot Tub
Guest House
Other:
Clear selection
Does your house have any decks, porches, or balconies? If so, what is the square footage?
Your answer
How many bathrooms are in your house?
1
1.5
2
2.5
3
Other:
Clear selection
Do you have a fire place in your house?
Yes
No
Clear selection
Do you have a wood burning stove in your house or any outbuilding?
Yes
No
Clear selection
What year was the last update to your Electrical System?
Your answer
What year was the last update to your Plumbing?
Your answer
What year was the last update to your Heating/AC System?
Your answer
What year was your roof last replaced?
Your answer
What Deductible do you currently have?
Your answer
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