1Start2Home Basics3Owners Name First Middle Last Date of birth MM slash DD slash YYYY Property address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code The property address is different than the mailing address. The property address is different than the mailing address. Mailing address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Do you have an Auto policy? Yes No When would you like this Homeowners policy to start? (If you don't know the exact day, estimate and change it later.) MM slash DD slash YYYY How many years have you owned this home?(Round to nearest year. If new home purchase, enter 0) Home styleSingle Family HouseCondominiumTownhouseManufactured/Mobile HomeMulti-Family HomeRowhouseNon-Traditional ResidenceIs this (or will this be) your primary home? Yes No Do any of these apply to you or this home? Yes No Under major renovation / construction? Currently has major damage? In foreclosure? In bankruptcy? Do any of these apply to you or this home?Do you do business with clients or customers in this home? Yes No (e.g. day care, tutoring, etc.)Details about your propertyEdit the information that is incorrect and save updates to keep goingYear built Square footage How many stories is this home?(not including basement)11.522.533.54Bi-LevelTri-LevelWhat is the architectural style?2-Family HomeAmerican 4-squareBasicBi-LevelBungalowCape CodColonialColonial - SpanishCompletely CustomContemporaryContractor ModernFarmhouseFolkLogMediterraneanRanchTri-LevelTudorVernacularVictorianWhat is the basement/foundation type?SlabBasementCrawl SpacePartial BasementPiers, Posts and PilesOpenWalkout BasementConstruction/structure typeFrameMasonryMasonry VeneerLogIs this home built on a slope? Yes No ExteriorAdditional StructuresDoes this home have any of the following? Garage/Carport Deck Pool Trampoline Garage/carport typeAttachedBasementBuilt-inCarportDetachedNumber of cars that can fit in the garage/carport?Please enter a number from 1 to 3.Does this home have a perimeter fence? Yes No Pool type Above ground In ground Does the pool have any of the following? Diving board Removable/Lockable ladder Slide (Select all that apply)Does the pool have any of the following safety barriers? 4 ft. fence with locking gate Surrounding wall Screened enclosure Other pool barrier (Select all that apply)Interior - KitchenPrimary counter material Plastic Laminate (i.e. Formica™) Granite or Marble Solid Surface (i.e. Corian™) Tile Concrete Quartz (Silestone) Stainless Steel Wood (Butcher Block) None (Pedestal sink) Other Living SpacesNumber of fireplacesPlease enter a number from 0 to 9.Type of fireplaceGasWood BurningWoodStove/FreestandingUtilities and Safety FeaturesWas this home ever heated by oil? Yes No Select all the fire safety features that apply to your home Smoke detectors Fire extinguishers Indoor sprinkler system Fire alarm system What type of fire alarm system do you have? Alarm that alerts you at home Alerts your phone Alerts your phone Alerts monitoring company directly Select all the home security features that apply to your home Deadbolts (all exterior doors) Security alarm system When was the last update to the electrical? When was the last update to the roof? When was the last update to the plumbing? What is the amperage of your home? 100 amps 150 amps 200 amps more than 200 amps Do you have a backup generator? Yes No Primary Owner First Middle Last Date of birth MM slash DD slash YYYY Marital statusSingleMarriedSeparatedDivorcedWidowedDomestic PartnerWould you like to add a co-applicant? Yes No (Someone listed on the title and living on the property should be included)Co-applicant First Middle Last Date of birth Relationship to ownerSpouseDomestic PartnerParentChildRelativeEmployeeOtherMarital statusSingleMarriedSeparatedDivorcedWidowedDomestic PartnerHow many people will live in this home? Contact InformationWhere would you like to send your policy info? Primary phone number Additional DetailsDo you have any pets or animals? Dogs Farm Animals (1-2) Exotic Animals Farm Animals (3+) Exotic animals: includes alligators, crocodiles, venomous snakes, primates, large cats and other non-domesticated animals usually found in the wild or in zoos. Farm animals: includes cows, chickens, roosters, pigs, horses, sheep, goats, turkeys etc. Do not answer for other animals, including ducks, geese, etc.Number of dogs Have any of your dogs ever bitten anyone? Yes No Name the dominant breed(s) Do you have home insurance today? Yes No How many years have you been with your current company? Home purchase date Date home occupied Number of home insurance claims in the last 5 years0123+Name of Employer
