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Homeowners Quote - Janet Sweeney

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information

First Name *

Last Name *

ZIP / Postal Code *

Primary Phone Number *

E-Mail Address *

Dwelling Information

Address of home to be insured *

Name of all person(s) on the deed and/or mortgage *

Date(s) of Birth *

Occupation(s) *

Current/prior address *

Closing Date *

Purchase Date *

Year of Construction *

Masonry or frame *

Are there any detached structures? *

Is this home a short sale or foreclosure? *

Mortgage Company Name *

Will it be your primary home or do you plan to rent it out? *

Roof Age *

Roof Material *

Do you have a wind mitigation inspection for this property? *

Is any part of the roof flat over living space? *

Do you have a favorable 4 point inspection? (for homes over 30 years)

Age of HVAC *

Age of hot water heater? *

Is your water heater tankless? *

Type of plumbing *

Any polybutylene, galvanized, copper or PEX?

What type of breaker box does the home have? *

Any cloth or aluminum wiring?

Will there be an alarm system at the home? If so, will it be monitored? *

Is the home on a paved road? *

Distance to a fire station *

Distance to a fire hydrant *

Is the home on a slab foundation? *

Any asbestos present?

Will there be any domestic animals? *

If so, what breed and is there any bite history? *

Will there be any farm or exotic animals? *

Will there be a trampoline? *

Is there a pool? *

If so, will there be a diving board or slide? Is it screened or fenced?

Is there any existing damage to the home? *

Are you aware of any sinkhole activity? *

Will there be any business activity on the property that involves client traffic? *

Any bankruptcies, repossessions or foreclosures in the past 5 years? *

Have you filed any claims for home insurance in the past 5 years? *

Are you aware of any claims filed on the home you are buying? *

Who is your auto insurance with? *

Will you need life insurance to cover this mortgage? *

Home Insurance does limit the coverage for jewelry, furs, silverware & guns within the policy. Do you have any items you’d like to schedule to policy? *

Submission Validation

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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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