Home Owners Insurance Step 1 of 4 25% Name*Email* Phone* List all owner(s) on title/deed (Including yourself)NameBirthdayRelationship to you Address of the home you want to buy insurance forHave you lived here for more than 3 years?YesNoPrevious Address Are you living in this house or renting it out as an investment?Primary Home (Owner lives here)Rental/Investment(Rented to tenants)Will you have any pets living with you?YesNoPet InfoType of AnimalBreedHas it ever bitten anyone before? Do you currently have homeowner insurance?YesNoHave you had any home/renter's claims before?YesNoDescribe Claim IndividuallyDate of ClaimClaim AmountDescription of Claim Did you ever have homeowner insurance?YesNoHave you had any home/renter's claims before?YesNoDescribe Claim IndividuallyDate of ClaimClaim AmountDescription of Claim If you had to replace everything you own today, how much money would you need?( Electronics, Furniture, Clothing, Equipment, Jewelry, Kitchen accessories, Engagement ring, Wine Collection, Vintage Arts, Luxury Watches, etc...)Does above include any one or more items worth over $3000?YesNoList each item worth over $3000 individuallyType of itemWorth/Cost to replace When was the last YEAR the following has been upgraded/renovated? Skip if you do not know (enter the year)RoofPlumbingElectricalHeadingPartial or Completed Upgrades? Skip if you do not knowRoofPlumbingElectricalHeadingDoes the house have a swimming pool?YesNoIs it fully fenced in, prevent unauthorized access from outside?YesNoDoes pool have a diving board?YesNoDoes house have a trampoline?YesNo
