Purchased (M/Y):		In a HOA?
If less than 2 years, what was your previous address:
Previous Address:		Previous City/State:	/	Previous Zip:
Dogs Count:		Breed:
Building Information
Address:		City/State:	/	Zip:
Year Built:		Foundation:		Pct Finished:
Sump Pump:
Stories:		Sq Feet:		Style:
Fire Hydrant:		Fire Station:		City Limits:
Interior Information
Kitchen Grade:		Bathrooms:	- Full - 3/4 - 1/2	Bath Grade:
Flooring:	Hardwood   Carpet   Tile   Laminate   Vinyl
Fireplace:	#	Wood Stove:		Last Inspected:
Heating:		Heating Updated:		Central Air:
Plumbing:	Updated:	Wiring:	Updated:	Household Smoker:
Exterior Information
Roof Material:		Roof Replaced:		Impact Resistant
Roof Replacement:		Sewer Concern?		Solar Panel Cnt:
Exterior Walls:		Garage:		Garage Sizes:	Cars
Deck:	Sq Ft	Patio:	Sq Ft	Porch:	Sq Ft
Hot Tub:		Pool:		Trampoline:
Detached Structure:		Detached Structure:		Detached Value:
Home Features
Dead Bolts:		Burglar Alarm:		Fire Alarm:
Protective Device:	Smoke Detector Fire Ext Sprinkers	Home Business:		Equipment Coverage:
Floaters:	$ Jewelry   $ Firearms   $ Collectibles
Do you plan to buy a new home or refinance in the near future?				What year?
Losses:
Notes: