Application Type---HomeFlood
Policy Type---HomeCondo
Date
Date of Birth
Phone Number (Type)---HomeCellWork
Co-Applicant?---YesNo
Number of Household Occupants: 1234567+
Property Occupancy? OwnerTenant
Purchase Date
Number of Stories: 1234+
Construction type: FrameMasonryModular
Type of foundation: SlabPiersHeight of PiersOther
Type of A/C & Heating: Central UnitWindowBoth
Is heating: GasElectric
Number of AC units: 123456+
Roof Type: Flat/ShedGableHipCross-GabledCross-HippedGambrelMansard Click here for photos of roof types.
Number of Fireplaces: 012345+
Fireplace type: WoodGas
Garage type (if any):CarportGarageAttachedDetached
# of cars: 012345+
Number of Bathrooms 12345+
Pool: Above GroundIngroundNone
Diving Board (if applicable): YesNo
Slide (if applicable): YesNo
Trampoline: YesNo
Pets: YesNo Unattached Structures?YesNo Renovations to the dwelling? YesNo If so:
