Personal Homeowners Inquiry

Contact Information
Home Owner Birthdate:
Who is your current insurance carrier?
Value of Dwelling (land not included):
Year built:
Square footage:
Number of Acres:
Do you maintain a business in your home?
Construction i.e., Frame, Brick, Stone, Mobile, Modular Log, ect.:
Type of Home i.e., Ranch, 2 Story, Farm, ect.:
Is there a basement or a crawl space?
If yes, what percent of it is finished?
Heat i.e., Natural Gas, Fuel Oil, Wood Heat, Propane Gase, ect.:
Is there a wood burner or fireplace on the premises?
Type of Roof:
Number of Bathrooms:
Miles from Fire Dept.:
Distance from Hydrant:
Any home owners claim in the last 3 years?
What type of animals do you have?
Do you have any garages, sheds, or pole buildings?
Do you have a trampoline, jacuzzi, pool