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Home Insurance Quote

First name

Email

Last name

DOB

Physical Address

Address line 2

City

Phone #

State

Zip

Year Built

Hip or Gable Roof?

Gable Roof: Two sides

Hip Roof: multiple sides and angles (typically newer construction)

Heated and cooled Square Footage

Construction Material

Roof Update, if so, when?

Foundation

Employer

Occupation

How long have you been employed?

Bankruptcies in the last 5 years?

Marital Status

If so, Spouse Name

Mobile Home

Year Built

Size

Purchase Year

Purchase Price

Model

Handrails over 3 ft on Entrances?

Tied down?

Skirted?

Distance to fire hydrant

Double Wide

Construction Type

Year Built (DW)

Square Footage

Purchase price

Purchase Date

Number of Stories

How many baths?

Type of Garage

Is there a pool?

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