Homeowners Insurance Quote

Home Information
How Long At Present Address	Year Home Was Built:
Ground Floor Square Footage (excluding garage and basement)	sq. ft.        Total Livable Square Footage
Type Furnace	Gas Electric Other Age of Furnace
Type of electrical service	100amp 75amp 150amp 200amp Other Unknown Age of wiring
Major additions in last 10 yrs	No Yes Explain
Number of Property Claims	0 1 2 3 4 5 Number of Liability Claims 0 1 2 3 4 5

Structure Information
Type	Construction	Roof	Foundation	Garage
1 Story 1 1/2 Story 2 Story Split Level Other Tri-Level Other	Frame Stucco Veneer Brick Other	Asphalt Shingle Wood Shingle Tile or Slate Other	Basement Crawl Space Slab Other	None 1 Car 2 Car 3 Car 4 Car
		Age of roof:  yrs.		None Attached Detached Basement Built-in Car Port

Features
Bathrooms	Basement	Deck/Porch		Fireplaces
# of Full 1 2 3 4 5 # of Half 1 2 3 4 5	None Finished Unfinished Sq. Ft	Deck Sq. Ft Porch Sq. Ft		# of Chimneys: # of Hearths:
Bedrooms	Living Room	Dining Room		Family Room
None 1 2 3 4	No Yes 1 2 3 4	No 1 2 3 4		No Yes 1 2 3 4
Woodburning Stove	Utility Room	Kitchen		Attic
No Yes	No 1 2 3 4	No Yes		No Unfinished Finished

Additional Features
Heating System	Central Air	Central Vac	Security Alarm	Satellite Dish	Smoke Detector
None Gas Electric Oil Propane Wood Solar Other	No Yes	No Yes	None Not Monitored Monitored	No Yes	No Yes