|
Dwelling Fire
Questionnaire
(rental
property only)
|
The following fields must be filled out completely and accurately
in order to obtain a quote. |
|
| Insured's
Name: |
|
| Mailing
Address: |
|
| E-mail |
|
| Address of Dwelling to be
Insured? |
|
| Prior
Carrier: |
|
| Is policy being
non-renewed? |
|
| # of
Claims |
|
| Occupancy of
Dwelling? |
|
| Annual or
Seasonal Rental? |
Annual:
Seasonal: |
| Year
Built: |
Number of
Stories: |
| Construction (Brick or
Frame) |
|
| Square Footage of Living
Area |
|
| Other Structures not
attached to the House? |
|
| Central
Heat |
|
| Wood burning
stove? |
Prefab Fireplace? |
| If so, was it
professionally installed? |
|
| # of smoke
alarms |
|
|
If
the dwelling is over 20 years old, answer the
following:
|
| Wire
updated? |
|
| Plumbing? |
|
| Heating? |
|
| Building Cvg
amount |
|
| Built on: |
Slab:
Crawlspace:
Basement: Pilings: |
| Contents Cvg
amount |
|
| Additional
Comments: |
|
| Before a quote can be bound, we may need a picture of
the front & back of the dwelling. You can e-mail pictures to personal@woodburyinsurance.com.
Also, all questions must be answered in order to give an accurate
quote. |
|
|
