Building Information Type of Home * Single Family Home Duplex Townhome Mobile Home Other
Please enter the type of building to be insured.
Year Built *
Please enter the year this building was constructed.
Construction Type * Mostly Wood Frame Mostly Brick Stucco Other
Please enter the construction type of the building to be insured.
Foundation * Basement Fully Finished Basement Half Finished Basement Unfinished Crawlspace Slab Other
Please enter the type of foundation the building is on.
Roof Type * Asphalt Shingle Tile Concrete Other
Please enter the type of roof. If there are multiple roof types, please include that in the additional comments below.
Roof Age * Under 5 Years 5-10 Years Over 10 Years
Please enter the age of the roof. When was it last replaced?
Square Footage *
Please enter the approximate square footage of the home.
Primary Heating * Gas (Forced Air) Electric Hot Water Radiator Oil/Coal/Kerosene Propane Stove
Please enter the primary heating source in the building to be insured.
Bedrooms * 1 2 3 4 5 6 7+
Please enter the total number of bedrooms.
Bathrooms * 1 1.5 2 2.5 3 3.5 4+
Please enter the total number of bathrooms.
Stories * One-Story Bi-Level Two-Story Tri-Level Other
Please enter the total number of stories in the home.
Garage Type * Attached - 1 Car Attached - 2 Car Attached - 3 Car Attached Car Port Detached - 1 Car Detached - 2 Car Detached - 3 Car Detached Car Port No Garage Other
Please enter the type of garage if one exists on the premises.
Select any additional property features that apply. *
Please select all that apply.
Is your home located in a flood plain? * Yes No Not Sure Security System * None Monitored Unmonitored Unsure
Please enter the type of security system in the home.
Municipal Location * Inside City Limits Outside City Limits Unsure
Please enter whether the home is located within the local city limits.
Fire Alarm * None Monitored Unmonitored Not Sure
Please select the type of fire alarms that currently exist in the home.
Do you have any of the following breeds of dogs: Chow, Doberman, German Shepherd, Pit Bull, Rottweiler, Wolf Hybrid or a mix of these? * Yes No
Failure to answer this question truthfully can result in a denied insurance claim.