Homeowners
Please answer the below questions to reflect any changes within the last 12 months.
Full Name
*
Who is your agent?
Did your mortgage lender change in the last 12 months?
No
Yes
Please list your current mortgage lender
Is your home deeded in the name of a trust?
No
Yes
What is the name of the trust and who are the trustees?
Did you recently renovate or make any significant structural additions to your home?
No
Yes
Did you have your roof replaced?
No
Yes
Date of replacement
MM slash DD slash YYYY
Did you update any of the following in the last 12 months?
Wiring
Heating
Plumbing
None
Wiring Date of replacement
MM slash DD slash YYYY
Heating Date of replacement
MM slash DD slash YYYY
Plumbing Date of replacement
MM slash DD slash YYYY
Did you have a burglar, fire or safety alarm system installed?
(Monitored by companies such as ADT, Brinks, etc.)
No
Yes
Did you have a gas alarm installed?
(Such as carbon monoxide alarm or automatic gas main shut-off)
No
Yes
Did you get a new dog?
No
Yes
Please list breed
Did you add solar panels to your home?
No
Yes
Do you own or lease the panels?
Own
Lease
How many panels do you own?
Please list the purchase price of the solar system
Did you have a pool, spa or sauna installed?
None
Pool
Spa
Sauna
Does the pool have a diving board or slide?
No
Yes
Did you install a trampoline?
No
Yes
Is it netted?
No
Yes
Do you conduct business or work from home?
No
Yes
What type of business?
Do you have a wood burning fireplace?
No
Yes
Do you have collectibles: antiques, fine art, stamps, coins, etc.?
No
Yes
What do you collect?
Do you own jewelry pieces valued over $2,500?
No
Yes
Average dollar value per collectible?
Do you currently rent or do you intend to rent your home to a third party, including home exchanges and short-term rentals via AirBnB, VRBO or other companies?
No
Yes
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