Home Fact Finder .pdf

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Original filename: Home Fact Finder.pdf
Title: Editable Form
Author: Tom J Merker

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Date _______________
Property/Policy Type ?

Producer/Office

Telemarketer

Homeowners

Time
Condo

Man Home

____________________

Landlord

Owner Info: Email __________________________ Phone____________________

Renters

?

Marital Status _______

First Name ___________________ MI ____ Last ___________________________ DOB _________________ M

F

Spouse

F

____________________ MI ____ Last ___________________________ DOB _________________ M

?
Current Address _____________________________ City ____________________ Zip _________ How Long? _______
Total # of Occupants

Previous (If < 5 yrs) _________________________ City ___________________ Zip _________ Including Children

Prop to be Insured:(Ck if same)

Choose

Address _____________________________ City _________________ Zip _______

Ranch
?
Purchase Date _____________ Mortgage ? ?____ Who Pays Insurance? __________
Style of Home _____________
?
# _____ Garage _____

__________
MAN HOME

Choose One

Yr. Built _______ Sq. Ft. ________

Fdn. Type 1_______________________ % ______

Choose One
None
(Type) _________________
Fdn. Type 2_______________________
% ______

Size L

W

Park Size

Choose

?
0
1 Kitchens _____
1 Full Baths _____
0 ¾ Baths _____Fireplace
0 ½ Baths _____
(Choose Quantities) _____
- (Type) _______
__ %__

Roof Style Choose
_ %__

________________

Choose

______

________________

Choose

______

Choose
________________

______

Exterior Walls

Heat & A/C

__%__

Special Features

Choose Roof______
Type
____________

Choose
__________

______

Choose
_________________

______

Year of Roof

Choose
__________

______

Choose
_________________

______

Choose
_________________

______

____________ ______

Wood Deck Type ___________________
Choose Type

Quantity

Choose
_________________
______
Sq. Ft. or Size _____________________
Choose Quantity, Type, and Size of Other Structures (Screened In or Open Porches, Sheds, In-Ground Cement Pools,
Solar Rooms) *See Size Chart*

Total # of Household Vehicles 0

OTHER STRUCTURE SIZE CHART

Quan

Type

Size

_____

Choose
___________________

Size
_________

_____

Choose
___________________

Size
_________

_____

Choose
___________________

Size
_________

_____

Choose
___________________

Size
_________

Other Items (Check All That Apply):

Structure

Small

Med

Large

SHED
PORCHES
SOLAR ROOM
CEMENT POOL

8’ x 16’
8’ x 12’
150 SQ FT
400 SQ FT

20’ x 40’
12’ x 12’
350 SQ FT
650 SQ FT

30’ x 50’
12’ x 20’
650 SQ FT
900 SQ FT

Pool___ Hot Tub ____ Gazebo ____ Pole Barn ____ Alarm

Multi-Policy Discounts ________________ Current Ins Co. _____________________ Long ? None
Dwelling Coverage __________________ Liability Choose
_____________
Deductible _________
Choose One
One
Please add any additional comments:
How

Exp______
Pers Prop $


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