Insured Information
Type of Customer*:Personal Customer Commercial Customer
Preferred Method of Contact:
E-Mail Home Phone Cell Phone Work Phone USPS Fax
Property Information:
Purchase Date*:
Property Address(if different from above):
Type of Residence*:Single Family Home Multiple Family
Site Access*:Flat Area/Easy Access Roads Mountain Region Slightly Congested Roads Narrow/Hillside Area Difficult Access/Steep Terrain Island Access-Short Distance Island Access-Long Distance Elevator Access Isolated Rural Area
Number of Families*:
Style:1 Story 1.5 Story 1.75 Story 2 Story 2.5 Story 2.75 Story 3 Story 3.5 Story 3.75 Story 3.75 Story 4 Story 4.5 Story 4.75 Story 5 Story Back Split Bi-Level Bi-Level/Row Center Bi-Level/Row End Bungalow Cape Cod Colonial Contemporary Cottage Federal Colonial Mediterranean Ornate Victorian Queen Anne Raised Ranch Rambler Ranch Row House Center Row House End Southwest Adobe Split Foyer Split Level Substandard Town House Center Town House End Tri-Level Tri-Level/Row Center Tri-Level/Row End Victorian Condo/Co-Op Multi-Wide Multi-Wide, Starter Home Single-Wide Single-Wide Starter Home
Year Built*:
Number of Stories*(different from "STYLE":
Occupancy*:Primary Dwelling Secondary Dwelling Vacation Home Seasonal Dwelling
Current Replacement Cost Insured for:
Estimated, Current Market Value:
WALL HEIGHT:
Fire Hydrant w/in 1000 Feet?:Yes No
Visible From Other Dwellings?:Yes No
REPLACEMENT COST INFORMATION:
Construction Material*:Frame(wood) Masonry Vaneer Fire Resistive None of the Above
Exterior Wall Material 1*:Brick on Frame (Brick Vaneer) Siding, Aluminum Siding, Vinyl Siding, Vinyl, Custom Siding, Vinyl, Shake/Shingle Siding, Wood Siding, Wood, Custom Stucco on Frame Stucco on Frame, Custom Stucco on Masonry Adobe Adobe with Stucco Adobe, Brick on Masonry Aluminum on Masonry Breezeway Wall Brick on Frame Brick on Frame, Custom Brick on Masonry Brick on Masonry, Custom Brick, Solid Brick, Solid, Custom Brownstone on Frame Brownstone on Masonry Brownstone, Solid Cement Fiber Shingle on Masonry Cement Fiber Siding on Masonry Clapboard on Masonry Concrete Block Decorative, Painted Concrete Block, Painted Concrete, Poured-in-Place, 4" to 6" Concrete, Poured-in-Place, 7" to 10" EIFS on Frame EIFS on Masonry Faux Panel Faux Panel, Custom Fieldstone on Frame Fieldstone on Masonry Glass Block Granite on Masonry Greenhouse Wall Half-Timber and Brick on Frame Half-Timber and Brick on Masonry Half-Timber and Stucco on Frame Hardboard on Masonry Limestone on Frame Limestone on Masonry Logs, Solid Marble on Masonry Masonry, Plain Masonry, Plastered New England Shingle on Masonry Sandstone on Frame Sandstone on Masonry Shakes, Victorian Scalloped Shakes, Wood Shingles, Cement Fiber Shingles, Pine Siding, Barn Plank Siding, Barn Plank, Custom Siding, Cement Fiber Siding, Clapboard Siding, Clapboard, Redwood Siding, Hardboard Siding, Logs Siding, Logs, Custom Siding, Logs, Deluxe, Half-Round Siding, Logs, Deluxe, Hand-Hewn Siding, Logs, Deluxe, Oversized Siding, Plywood Only Siding, Steel Siding, T-111 Slump Block Split Rock on Masonry Steel on Masonry Stone on Frame Stone on Frame, Custom Stone on Frame, Polished Face Stone on Frame, Sawn Face Stone on Frame, Seam Face Stone on Frame, Split Rock Stone on Masonry Stone on Masonry, Custom Stone on Masonry, Sawn Face Stone on Masonry, Seam Face Stone, Solid, 12" Stone, Solid, 12", Custom Stone, Solid, 18" Stone, Solid, 18", Custom Stone, Solid, 24" Stone, Solid, 24", Custom Stone, Solid, 8" Tile, Clay, with Back-Up Vinyl Shake/Shingle on Masonry Vinyl on Masonry Wood Siding on Masonry
Exterior Material Percentage 1*:
Exterior Wall Material 2:Brick on Frame (Brick Vaneer) Siding, Aluminum Siding, Vinyl Siding, Vinyl, Custom Siding, Vinyl, Shake/Shingle Siding, Wood Siding, Wood, Custom Stucco on Frame Stucco on Frame, Custom Stucco on Masonry Adobe Adobe with Stucco Adobe, Brick on Masonry Aluminum on Masonry Breezeway Wall Brick on Frame Brick on Frame, Custom Brick on Masonry Brick on Masonry, Custom Brick, Solid Brick, Solid, Custom Brownstone on Frame Brownstone on Masonry Brownstone, Solid Cement Fiber Shingle on Masonry Cement Fiber Siding on Masonry Clapboard on Masonry Concrete Block Decorative, Painted Concrete Block, Painted Concrete, Poured-in-Place, 4" to 6" Concrete, Poured-in-Place, 7" to 10" EIFS on Frame EIFS on Masonry Faux Panel Faux Panel, Custom Fieldstone on Frame Fieldstone on Masonry Glass Block Granite on Masonry Greenhouse Wall Half-Timber and Brick on Frame Half-Timber and Brick on Masonry Half-Timber and Stucco on Frame Hardboard on Masonry Limestone on Frame Limestone on Masonry Logs, Solid Marble on Masonry Masonry, Plain Masonry, Plastered New England Shingle on Masonry Sandstone on Frame Sandstone on Masonry Shakes, Victorian Scalloped Shakes, Wood Shingles, Cement Fiber Shingles, Pine Siding, Barn Plank Siding, Barn Plank, Custom Siding, Cement Fiber Siding, Clapboard Siding, Clapboard, Redwood Siding, Hardboard Siding, Logs Siding, Logs, Custom Siding, Logs, Deluxe, Half-Round Siding, Logs, Deluxe, Hand-Hewn Siding, Logs, Deluxe, Oversized Siding, Plywood Only Siding, Steel Siding, T-111 Slump Block Split Rock on Masonry Steel on Masonry Stone on Frame Stone on Frame, Custom Stone on Frame, Polished Face Stone on Frame, Sawn Face Stone on Frame, Seam Face Stone on Frame, Split Rock Stone on Masonry Stone on Masonry, Custom Stone on Masonry, Sawn Face Stone on Masonry, Seam Face Stone, Solid, 12" Stone, Solid, 12", Custom Stone, Solid, 18" Stone, Solid, 18", Custom Ston
