Please enable JavaScript in your browser to complete this form.Your Name *FirstLastYour Phone Number (include area code) *Property Full Address: *Residence Occupancy: *Primary ResidenceSecondary or Seasonal ResidenceRental Property- Tenant OccupiedVacation Rental / Airbnb UsageBe sure to indicate if home is rented as an Airbnb. Failure to do so will affect claims coverage.* home? claims Garage Square Footage (Include Attached Garage Square Footage) *Year Built: *Number of stories:One storyTwo storyManufactured HomeRoof Type *Asphalt/Comp ShingleMetalTileWood ShakeOtherAge of Roof: *Year replaced? If original roof, year house built?Heating *Forced AirWoodstovePellet StoveBaseboard HeaterFireplace insertPropane tank on premisesCheck all that apply.Updates: *HeatingPlumbingElectricalNoneExterior Wall Finish *Wood Siding T-111BrickStuccoFiber CementVinylOtherInterior FlooringHardwood FlooringLaminate FlooringCarpetTileLinoleum / VinylCheck all that apply.Loss History / Reported claims in the past 10 years? *Water lossFire lossWind lossNoneCheck all that apply.Brush clearance around home? Defensible space: *Yes- GoodNo- BadMaybe- Could be betterNeighbors home within 30 feetClean, park-like setting? Trees limbed up?Nearest Fire Hydrant: *Within 500 feetWithin 1000 feetOver 1000 feetDistance to nearest fire department: *Estimate miles distance from property.Anything else we need to know? New purchase, current insurer, cancellation or non-renewal, etc.Submit
