What is your Name?

What is your date of birth?

PLEASE NOTE: If you are a current SBIS client please leave questions 2-6 blank since we already have this info.

If the property is co-owned what is the name of the secondary property owner?

If the property is co-owned what is the date of birth of the secondary property owner?

What is your address?

What county do you live in?

What is your phone number or email address?

Is your Home Brick, Frame or Siding?

How many families live in your Home?

Is your home inside or outside of the city limits?

Approximately how many feet is your home from a fire hydrant?

What is the approximate value of your Home?

In what year was your home built?

If you home is over 30 years old, please list renovations that have been completed.

PLEASE NOTE: Some examples of renovations would be Plumbing, Heating, Roofing or Electrical repairs or improvements.

What is the approximate value of your home?

Do you own other homes? If yes, please list locations.

What is your current Liability limit with your current homeowners policy cover?

What amount of Medical Payments does your current homeowners policy cover?

Do you have coverage for Schedule Items on your current homeowners policy?

Do you have Watercraft/Snowmobile liability with your current homeowners policy?

Do you have Pets? If yes, what type of pets do you have? How many & what breeds?

Who is your current insurance carrier?

What is your current annual premium?

Who pays your premium?

Please list your losses in the last 5 years.

How many stories does your home have?

What is the square footage of your ground floor?

Do you have a finished attic? If yes, what is the square footage of your finished attic?

How many full bathrooms are in your home?

How many half bathrooms are in your home?

Do you have a full basement? If yes, what is the square footage and is it finished?

Do you have a crawl space?

Are you on a slab?

Do you have a breezeway?

Do you have a porch? If yes, what is the square footage?

Do you have a balcony or deck? If yes, what is the square footage?

Do you have a fireplace? If yes, how many chimneys or hearths?

Do you have central air conditioning? If yes do you have separate ducts?

Do you have a garage? If yes, is it attached?

Do you have a built-in basement carport?

What is the effective date of your current homeowners policy?

Do you have a swimming pool? If yes, is your swimming pool fenced in?

Does your swimming pool have a diving board or a slide?

(If you are not comfortable with sharing your social security numbers with us via this format. Please feel free to contact us toll free @ (866) 724 7123. Unfortunately, we can not obtain homeowner insurance quotes without it). If you are unsure about any of the above coverage specific questions, please feel free to fax your current homeowners schedule page to us at (630) 924 7833.

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