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Home Quote
Full Name
Date of Birth
DL #/State
Marital Status
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Phone Number
Email
Education
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Occupation
2nd Name Insured's Full Name
2nd Name Insured's Date of Birth
2nd Name's Occupation
2nd Name's Education
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2nd Name's DL #/State
# of People in Household
Property Address
Property Type
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Prior Address
Current Insurance Carrier (type N/A if none)
Effective Date
Purchase Date
Year Built
Current Loan Amount
Square Footage/LxW
Foundation Type
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Year of Roof
Roof Type
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Exterior Wall Type
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Pool?
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Fireplace?
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Gated Community?
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# of Bathrooms
# of Bedrooms
# of Stories
HVAC?
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Year of HVAC Unit
Primary Heat Type
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# of Prior Claims
#/Type of Dogs
Business Conducted at Property? Examples: Day Care/Salon
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Make/Model/Serial # (For Manufactured/Modular/Tiny Homes)
Select All That Are Present
Monitored Cameras
Smart Camera(s)
Monitored Alarm System
Tankless Hot Water Heater
Backup Generator
Smart Automatic Water Shut Off
Tree Free Yard
Mailing Address (If Different than Property Address)
Date Quote is Needed By
Additional Info
Current Home Declaration
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