Homeowners

Please answer the below questions to reflect any changes within the last 12 months.

"*" indicates required fields

Full Name*

Please select your agent's name

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Agent's Email

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

Did you update any of the following in the last 12 months?

Wiring

Heating

Plumbing

None

Wiring Date of replacement

Heating Date of replacement

Plumbing Date of replacement

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?

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

2+2=?*

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First name*

Last name*

Email*

Phone*

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Homeowners

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