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» POLICY HOLDER |
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of location to be insured
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» PROPERTY |
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paid by insurance company
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If built over 20 years ago, we will need renovation or replacement dates for your roof, plumbing, electrical system, hot water heater, and main heating system. Examples of these would include replacing toilets or a kitchen sink, replacing lighting fixtures, increasing amperage of electrical service, or having an annual service performed on the water heater or main heating system.
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| roof: |
month/year (xx/xx) |
| plumbing: |
month/year (xx/xx) |
| electrical: |
month/year (xx/xx) |
| hot water heater: |
month/year (xx/xx) |
| heating system: |
month/year (xx/xx) |
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| alarm: |
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| Do you own a dog? If so, what breed? |
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| dwelling replacement cost: |
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| personal liability limit: |
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Where did you hear about us?
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