Buying a home is one of the single largest investments that most people ever make. If you need to protect that investment, your main line of defense is homeowners insurance.

Most standard homeowners insurance policies will provide coverage for damage to your home (and many of the items in your home) caused by theft, fire and lightning, smoke, frozen pipes and ice and snow. Read your homeowners insurance policy to find out exactly what is and is not covered. Do this before you suffer a loss, so you won't be surprised. Most insurers exclude damages caused by an act of war, nuclear accident, flood, earthquake, and terrorism, although you may be able to purchase special policies or endorsements that will cover these events.

Mortgage lenders require that borrowers purchase a minimum amount of homeowners insurance (typically equal to the appraised value or the purchase price of the home). But this is often not the amount of coverage you truly need. Instead, find out how much it would cost to rebuild your home, and consider insuring it for that amount.

1. Property type:
2. Address of Property:
3. City:
4. State:
5. Zip Code:
6. Year the property was built:
7. What type of insurance coverage do you need?
8. Number of individuals residing in the home:
9. Is anyone in the household a smoker?
Yes No
10. Are there any pets?
Yes No
11. What is the total square footage of the home?
12. What is the total number of floors (except basement)?
13. How many bedrooms?
14. How many bathrooms?
15. Description of basement:
16. How is the home heated?
17. If your property is oil heated, where is the oil tank located?
18. Total number of fireplaces:
19. Is there a garage?
Yes No
20. Description of garage:
21. If applicable, how many vehicles does your garage hold?
22. What is the number of porches, patios or decks on your property?
23. Style of home:
24. Exterior walls of structure:
25. Type of roof:
26. Is your home located within 1,000 feet of a fire hydrant?
Yes No
27. How far is your home from a manned fire station?
28. Does your home have a security system?
29. Please check all that apply.
Deadbolt Locks
Yes No
Wood Stove
Yes No
Tennis Court
Yes No
Central A/C
Yes No
Smoke Detectors
Yes No
Fire Extinguisher
Yes No
Swimming Pool
Yes No
Yes No
Uncovered Patio/Deck
Yes No
Central Alarm System
Yes No
Hot Tub
Yes No

30. Please describe in detail any homeowners/renters claims made in the last 5 years.

31. Do you want Dwelling Coverage?
Yes No
32. Approximate Dwelling Coverage (Replacement value less land):
33. Requested deductible:
34. Requested liability coverage:
35. Would you like Replacement Cost Coverage on Contents?
Yes No
36. Additional Coverage:
Description 1:
Description 2:
Description 3:
First Name:
Last Name:
Street Address:
Zip Code:
Best time to contact:

Please provide any additional information that may affect your quote.

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