| Year Home Built: |
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| Home Square footage: |
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Is this Builder's Risk?
(new home constr.)
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Month/Year home to be complete:
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| Number of units: |
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| Type foundation: |
(If basement, what % is finished?)
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| Type Construction: |
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| Type Roof: |
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| Number of stories: |
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Do you own animals or pets?
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If yes, list type/for dogs, list breed:
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| Are You Near Brush Area? |
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| # of feet to nearest
fire hydrant |
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| # of miles to nearest
fire station: |
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Does Home Have a Garage?
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Tell whether built in, detached/ attached, and how many cars?
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| Currently Insured? |
Name of Carrier & how long insured?
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| Current Premium |
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| Prior Claims? |
Describe claims in detail:
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| Rate Your Credit History and Past Insurance Payment History: |
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| Plumbing Type: |
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| Heating Type: |
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| Circuit Breakers or fuses? |
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Special features:
(i.e., deck, air conditioning, alarm systems, pool, etc.) |
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Comments/Remarks:
(describe any scheduled jewelry, in-home business, oil tank location, or other special coverages/remarks here): |
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| Send my quote via: |
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