Home Information
Dwelling Type
Single Family
Duplex
Multi Family
Townhome
Condominium
Mobile Home
Property Type
Economy
Standard
Luxury
Construction Type
Wood Frame
Metal Frame
Masonry
Log Home
Other
Exterior Type
Brick
Vinyl Siding
Stucco
Veneer
Stone
Wood
Aluminum Siding
Cinder Block
Other / Not Sure
Roofing
Asphalt Shingle
Composition Shingle
Wood Shingle
Tile Shingle
Metal Roof
Flat Roof
Other
Heating
Electric
Natural Gas
Propane
Boiler
Stove
Other
Construction Type
Wood Frame
Metal Frame
Masonry
Log Home
Other
How Many Stories
1
1 1/2
2
3
4+
Bi-Level
Tri-Level
Bedrooms
1
2
3
4
5
6
7
8
9
Bathrooms
1
1 1/2
2
2 1/2
3
3 1/2
4
4 1/2
Fireplaces
0
1
2
3
4
4+
No Garage
Carport
Attached – 1 Car
Attached – 2 Cars
Attached – 3 Cars
Not Attached – 1 Car
Not Attached – 2 Cars
Not Attached – 3 Cars
Security System
No
Yes, With Monitoring
Yes, A Home-only
Foundation/Basement
Less Than 50% Finished
More Than 50% Finished
Crawl Space
Open (Cement Non-Solid)
Piers, Pilings or Stilts
Slab (Cement Solid)
Other / Not Sure
Currently Insured
1
1 1/2
2
2 1/2
3
3 1/2
4
4 1/2
Contents Value
$ 5000
$ 10000
$ 15000
$ 20000
$ 25000
$ 50000
Liability Coverage
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000+
Deductible
$100
$250
$500
$1,000
$2,000
$2,500
$5,000
Number of Families
1
2
3
4
5
6
7
8
9
Current Residence
Less Than 1 Year
1 Year
2 Years
3 Years
4 Years
5 or More Years
Credit history
Excellent
Good
Fair
Poor
Claims in Last 5 Years
None
1
2
3
4+
Personal Information
Marital Status
Single
Married
Divorced
Separated
Partner
Insured?
Yes
No
Own?
Home
Condo
Time to Call
ASAP
Anytime
Morning
Afternoon
Evening