Home Insurance

Name:

Phone:

Email:

What is your full address including postal code for your home?

Have you had any claims in the past 5 years?

When is your birthdate?

Year

Month

Day

Have you had any cancellations for non-payment in the past 5 years?

How many years have you been continuously insured?

How many years have you been with your current insurer?

What year was your home built?

What is the square footage of your home?

What is the structure type (detached, semi, link, etc.)?

Do you have a security system/burglar alarm?

Yes

How many smoke detectors do you have?

Is there a pool (and if so, is it inground or above ground)?

What type of electrical do you own (breakers or fuses and how many amps)?

What year was the electrical upgraded last?

What is the type of plumbing (example: copper, plastic - % of each)?

What year was the plumbing upgraded?

What type of heating does your home have (natural gas central furnace, wood stove, oil, baseboards or space-heaters)?

When was the heating upgraded?

What type of roof do you own (steel flat, asphalt shingles, etc.)?

What year was the roof updated?

Do you have any outbuildings on the property (example a detached garage)?

Do you have a home-based business?

Do you have a mortgage?

Yes

Are you all non-smokers?

How many full bathrooms are there?

How many half bathrooms do you have?

Is there a basement and if so, is it finished?

Do you have a porch or a deck (and if so, what is the square footage)?

Are you okay with a soft-hits credit check? It won’t affect your credit, but it may lower the premium with 5 of our 10 companies.

When did you move into your home?