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Homeowners or Cabin Information Request Form

Full Name

Phone #

Date of Birth

Social Security #

Property Address

Current Occupation

Employment Address

Highest Education Level Completed

Current Insurance Company?

# of months with Company

Effective Date

Current Insured Value $

Year Built

# of stories

Deductible $

Livable square footage

# of smoke detectors

# of Bathrooms

% of Basement Finished

When has the Roof been re-shingled? Year:

Siding Type

When has the Electrical Wiring been updated? Year:

Breakers

Fuses

Electrical Amperage #

When has the Plumbing been updated? Year:

Type of Plumbing:

Copper

PVC

Galvanized

Is there second floor plumbing?

What’s the condition?

When has the Heating Plant been updated? Year:

Is it Gas Forced Air or Boiler system?

Are there any plans in the future to update the utilities? If so when?

Is there a garage?

Attached or Detached? ( 1-car 2-car 3-car )

Do you have a swimming pool or trampoline?

if so, do you have diving board or slide?

Do you have a security system?

if so: (local OR central station reporting)

Do you want Sewer Water Backup/ Sump Pump Coverage?

Email Appraisal to: [email protected] (optional)

Mortgagee Clause:

Loan #

Mortgage Amount: $