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? Yes No Previous 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? Yes No Pet InfoType of AnimalBreedHas it ever bitten anyone before? Do you currently have homeowner insurance? Yes No Have you had any home/renter's claims before? Yes No Describe Claim IndividuallyDate of ClaimClaim AmountDescription of Claim Did you ever have homeowner insurance? Yes No Have you had any home/renter's claims before? Yes No Describe 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? Yes No List 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? Yes No Is it fully fenced in, prevent unauthorized access from outside? Yes No Does pool have a diving board? Yes No Does house have a trampoline? Yes No
