Agent filled home quote 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 If insured has lived at new property for less than 2 years, please list previous address below. If new purchase, include closing date 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 Year built 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 Foundation Type * Cement slab Pier and beam or crawlspace Other Roof Type * Composition/Ashpalt Shingle Architectual shingle Concrete tile Clay tile Metal Flat Other Age of Roof * Select the year roof was completely replaced. Original roof 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 Older than 15 years Does roof have solar panels? * Yes No If yes, how many? Heating & Cooling * Central Air & Heat Other Number of Stories Square Feet Distance from fire station? Number of Bedrooms * 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 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 Garage Detached/separate garage 1 car attached 2 car attached 3 car attached 4 or more car attached None/carport only Wood Deck Yes No 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 Gated Community? Yes No 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 Payment Type Escrow Paid in Full Monthly Thank you! Your info has been sent to one of our agents. We will contact you shortly with some rates!
