HOME REPLACEMENT COST
ESTIMATE REQUEST

We at Hudson & Muma believe that it is important to offer our customers the most up-to-date technology available which will enhance the service they receive. It is because of this commitment that we are offering this form to aid in generating accurate applications and forms quickly and efficiently!

Remember, without complete information, we may be delayed in producing your quote, so please complete ALL applicable fields.

SUBMITTING THIS FORM YOU ARE AGREEING TO THE CONDITION THAT NO MATERIAL CHANGE WILL BE MADE TO YOUR POLICY UNLESS AND UNTIL YOU RECEIVE CONFIRMATION OF THAT CHANGE FROM A HUDSON & MUMA ASSOCIATE OR AN ASSOCIATE THAT THE INSURANCE COMPANY WRITING THE COVERAGE.
* Indicates required fields

    Effective Date:


    Insured Information

    Type of Customer*:
    Personal CustomerCommercial Customer









    Preferred Method of Contact:

     


     

    Property Information:

    Purchase Date*:

    Property Address(if different from above):

    Type of Residence*:

    Site Access*:

    Number of Families*:

    Style:

    Year Built*:

    Number of Stories*(different from "STYLE":

    Occupancy*:

    Current Replacement Cost Insured for:

    Estimated, Current Market Value:

    WALL HEIGHT:

    "%": Height(ft.):

    Fire Hydrant w/in 1000 Feet?:YesNo

    Visible From Other Dwellings?:YesNo

     


     

    REPLACEMENT COST INFORMATION:

    Construction Material*:

    Exterior Wall Material 1*:

    Exterior Material Percentage 1*:

    Exterior Wall Material 2:

    Exterior Material Percentage 2:

     


     

    Roof Style/Slope 1*:

    Roof Style 1 Percentage*:

    Roof Style/Slope 2:

    Roof Style 2 Percentage:

    Roof Style/Slope 3:

    Roof Style 3 Percentage:

    Roofing Cover 1*:

    Roofing Cover Percent 1*:

    Roofing Cover 2:

    Roofing Cover Percent 2:

    Roofing Cover 3:

    Roofing Cover Percent 3:

    Roof Shape 1*:

    Roof Shape Percentage 1*:

    Roof Shape 2:

    Roof Shape Percentage 2:

    Roof Shape 3:

    Roof Shape Percentage 3:

     


     

    FINISHED Living Area of Dwelling:(Do not include finished basement, built-in garage area or lower level unfinished area in the finished living area)

     


     

    Construction Type:

     


     

    Foundation Type and Percentage:

    Type: "%":
    Slab at Grade:
    Basement Below Grade:
    Basement Daylight:
    Basement Walkout:
    Crawlspace, Unexcavated:
    Crawlspace, Excavated:
    Pier:
    Hillside:
    Hillside Slope:

    Foundation Material and Percentage:

    Type: "%":
    Stone:
    Concrete:
    Brick:
    Block:
    Fieldstone:
    Wood:

    Basement Depth:

    Number of Basement Levels:

    Number of Basement Stairways w/Railing:

    Number of Basement Wide Stairways w/Railing:

    Basement Square Feet:

    Finished Basement Square Feet:

    Basement Finish & Percentage:

    Type: Total Number:
    Standard Finish:
    Custom Finish:

     


     

    Garage Type*(Ctrl or CMD + Click for multiple selections)

     


     

    A NOTE ABOUT GRADES:
    Throughout this form you will see different Construction "Grades", such as:
    1. Builders Grade -
    The quality of the finish and fixtures is that found in builder's standard spec houses - basically "standard" features, laminate or solid surface countertops.
    2. Custom Grade - The quality of the finish and fixtures is a level above Builders Grade - simulated marble or high end solid surface counters, solid wood cabinets and drawers, etc.
    3. Deigner Grade - The quality of the finish and fixtures is top end. Marbles, granites, exotic woods and the highest quality appliances. There is help available where you see the "?" icon.

     


     

    Number of BASIC Kitchen(s):

    Number of BUILDER Kitchen(s):

    Number of CUSTOM Kitchen(s):

    Number of SEMI-CUSTOM Kitchen(s):

    Number of DESIGNER Kitchen(s):

    Number of LUXURY Kitchen(s):

    Number of COMMERCIAL Kitchen(s):

     

    Full Baths:

    Number of BASIC FULL Baths(s):

    Number of BUILDERS FULL Baths(s):

    Number of CUSTOM FULL Baths(s):

    Number of SEMI-CUSTOM FULL Baths(s):

    Number of DESIGNER FULL Baths(s):

    Number of LUXURY FULL Baths(s):

    HALF Baths(sink and toilet) (See help under Full-Baths for guidelines):

    Number of BASIC HALF Baths(s):

    Number of BUILDERS HALF Baths(s):

    Number of CUSTOM HALF Baths(s):

    Number of SEMI-CUSTOM HALF Baths(s):

    Number of DESIGNER HALF Baths(s):

    Number of LUXURY HALF Baths(s):

    THREE-QUARTER Baths(sink, toilet and shower) (See help under Full-Baths for guidelines):

    Number of BASIC 3/4 Baths(s):

    Number of BUILDERS 3/4 Baths(s):

    Number of CUSTOM 3/4 Baths(s):

    Number of SEMI-CUSTOM 3/4 Baths(s):

    Number of DESIGNER 3/4 Baths(s):

    Number of LUXURY 3/4 Baths(s):

     


     

    HEATING TYPE:
    (Ctrl or CMD + Click for multiple selections)

    COOLING TYPE:
    (Ctrl or CMD + Click for multiple selections)

    FIREPLACES:

    Zero Clearance(#):1234

    Single:1234

    Double:1234

    Triple:1234

    Gas:1234

    Free-Standing Wood Stove:1234

    >Wood Pellet Stove:1234

     


     

    EXTERIOR ATTACHED STRUCTURES:

    Exterior Attached Structure 1:

    Exterior Attached Structure 1 Count & Sq Ft:

    Exterior Attached Structure 2:

    Exterior Attached Structure 2 Count & Sq Ft:

    Exterior Attached Structure 3:

    Exterior Attached Structure 3 Count & Sq Ft:

    Exterior Attached Structure 4:

    Exterior Attached Structure 4 Count & Sq Ft:

     


     

    SPECIAL EXTERIOR FEATURES:

    Type: Total Number:
    Atrium Windows:
    Stained Glass Window (small)
    Stained Glass Window (large)
    Picture Windows
    Exterior Storm Shutters
    Atrium Doors
    Sliding Glass Doors
    Solar Panels
    Bay Windows
    Bow Windows
    Small Skylights
    Large Skylights

     


     

    INTERIOR PARTITIONS:

    Type: % of Total:
    Drywall
    Drywall Textured
    Plaster
    Plaster Horsehair
    Block

     


     

    INTERIOR WALL COVERING:

    Type: % of Total:
    Paint
    Foil Wallpaper
    Vinyl Wallpaper
    Ceramic Tile
    Sheet Paneling
    Solid Wood Panelling
    Tongue and Groove
    Millwork
    Bookcase Walls
    Mirrors
    Knotty Pine Panelling

     


     

    CEILINGS:

    Type: % of Total:
    Drywall
    Acoustic Tile
    Plaster
    Wood
    Tongue and Groove
    Millwork
    Mirrors
    Tin

     


     

    FLOOR COVERING:

    Type: % of Total:
    Hardwood
    Vinyl
    Ceramic Tile
    Marble Tile
    Parquet
    Slate
    Carpet Over Hardwood Acrylic/Nylon
    Carpet Over Hardwood Wool/Berber
    Wall to Wall Carpet- Acrylic/Nylon
    Wall to Wall Carpet- Wool/Berber
    Plank
    Laminated
    Rubber
    Other

    Flooring, Other Describe:

     


     

    SPECIAL INTERIOR FEATURES:

    Type: # or SqFt
    Attic Finished(Sq ft.)
    French Doors(number)
    Hot Tub(number)