Homeowners Survey

Thank You For Completing Our Homeowner's Survey

In order to provide you with the most accurate analysis of insurance available with the top carriers, please complete this survey. Your help with answering these questions will prevent incorrect quotes and will limit contacting you for needed information.
Primary Insured Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Date of birth

MonthDayYear
DOB
Marital Status
Co-Insured Name

First NameLast Name
Co-Insured DOB

MonthDayYear
DOB
Marital Status
How many years have you been with your current homeowners insurance company?
How many years have you been continuously covered with homeowners insurance?
Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you rent or own it?

RENTOWN
When was your home built?
When did you purchase your home?

MonthDayYear
Date
Property Type

Single Family HomeSemi-attachedTownhouseCondoCo-opMulti-unit
What type of building is it?

Single familyDuplexTriplex/Fourplex
How would you describe the condition of the Exterior & Interior?

Needs workStandardHighExcellent
Number of stories
What is the square footage of your home (excluding basement)?
Square Footage
Is your basement finished?
Total square footage (including any finished portion of basement)?
Square Footage
In what year was your roof last replaced (your best recollection)?
Additional updates to the house

Heating UpdateElectrical UpdatePlumbing Update
If yes to any, please describe in detail
Who lives in your home?

Me OnlyMe and my spouseMe, spouse & childrenMe and my childrenOther
Total number of residents in your home?
Type of construction
Type of siding
How do you heat your home?

GasOilOther
Do you have any personal belongings of high value? (EX: Jewelry, Furs, Art)
Do you have any pets?

YesNo
If so, describe any pets including breeds.
Is there any bite history?

YesNo
If so, then please describe.
Do you have an in-ground pool?

YesNo
Do you have any of the following?

Fire alarmBurglar alarm
Have you filed any home or property claims within the past 5 years?

YesNo
If so, then please describe in detail
Optional. Please upload a copy of your current homeowners insurance declaration pages.

Browse Files

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Thank You For Completing Our Homeowner's Survey