Name * First Name Last Name Email * Phone (###) ### #### Preferred Method of Contact * Phone call Text message Email Date of Birth * MM DD YYYY Occupation * Co-applicant, if any Co-applicant's relationship Co-applicant Date of Birth MM DD YYYY Address of Property to Insure * Address 1 Address 2 City State/Province Zip/Postal Code Country County * Ex: Bexar County If you have lived at your current address less than 6 months, or you are closing on a new property, please list your previous address below Type of Property * Single Family Home Condo or Townhouse Mobile Home Occupancy * Owner Occupied 2nd or Vacation Home Tenant Occupied (6 month or more) Short Term Rental or Airbnb Vacant Construction Style * Choose best description of outside walls Mostly Brick and/or Stone (Greater than 50%) Hardiplank siding Stucco (Greater than 50%) Vinyl siding Aluminum siding Wood siding Asbestos Other Square Footage * Living area sq ft, not including garage Roof Type * Composition/Ashpalt Shingle Architectual shingle Concrete tile Clay tile Metal Flat Other Does roof have solar panels? * Yes No If yes, how many? Number of Bathrooms 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 Number of Floors 1 story 2 story Garage Detached/separate garage 1 car attached 2 car attached 3 car attached 4 or more car attached None/carport only Swimming Pool * None Above ground pool Ingound < 600 sq ft Ingound > 600 sq ft Safety and Security Features Smoke detectors Smart smoke detectors Fire extinguisher on premises Water leak detection device Alarm System * None Local siren only Monitored alarm service Smart alarm w/ monitored service If subscribed to security monitoring service, what company? * Neighborhood Security None Gated - keypad only Gated - guard at gate Pets Owned None cat(s) Small dog(s) (15 lbs and under) Large dog(s) (15 lbs and over) Pit bull, German Shepard, Rottweiler, Doberman, Akita or Chow Thank you! Your info has been sent to one of our agents. We will contact you shortly with some rates!
