Home Replacement Cost Appraisal Analysis Form

First Name - Insured 1

What is the insured's first name?

Last Name - Insured 1

What is the insured's last name?

Email address

What is the insured's email address?

Appraisal Address

What is the address of the home that was appraised?

Street Address Address Line 2 City State ZIP Code

Year Built

What year was this house built?

Appraising Insurance Company Name

What is the name of the insurance company that appraised the home?

Other Insurance Company Name

Please enter the name of the insurance company that appraised this home.

Replacement Cost Factors - Pre-Appraisal

Original Replacement Cost Estimate

Please enter the original replacement cost estimate.

Original Square Footage

Please enter the original square footage used to estimate the replacement cost of this home.

Original Cost per Square Foot

Homeowners Premium Proposed

Enter the proposed annual premium.

Replacement Cost Factors - Post-Appraisal

Replacement Cost Appraisal

What is the appraised replacement cost?

Appraised Square Footage

Please enter the total square footage of the living space listed on the appraisal.

Appraised Cost per Square Foot

Homeowners Premium Final

Enter the annual homeowners premium with the appraisal impact.

Replacement Cost Analysis

Appraisal Impact?

What impact did the appraisal have on the policy premium?

Increased the Premium
Decreased the Premium
No Impact on Premium

Premium Increase Due to Appraisal

Premium Decrease Due to Appraisal

Premium Descrease Due to Appraisal

Appraisal Change Processing Date

What date will the changes mentioned in the appraisal be processed?

Any Critical Requirements?

Are there any critical requirements from the appraisal that must be complied with?

Yes
No

Appraisal Requirements

Critical Requirements

Please select the critical requirements requested by the insurance company. (Select all that apply)

Install a central station fire alarm
Install a central station burglar alarm
Install an automatic water shutoff valve
Other

Other Critical Requirement

Please enter any other critical requirements from the appraisal below.

Critical Requirements Due Date

What date is evidence of the critical requirements needed.

Appraisal Automation Options

Appraisal Automation Check boxes

Please select the notifications you would like to trigger. (Note: A Zapier integration must be set up for these options to work.)

Email to client
Email to producer
Email to account manager
Email to carrier
Critical Requirement(s) reminder
Add data to spreadsheet

Client name

What is the client's name? (As you would like it to appear in the email.)

Client email

What is the client's email address?

Producer name

What is the producer's name? (As you would like it to appear in the email.)

Producer email

What is the producer's email address?

Account manager name

What is the account manager's name? (As you would like it to appear in the email.)

Account manager email

What is the Account manager's email address?

Carrier rep name

What is the carrier representative's name? (As you would like it to appear in the email.)

Carrier rep email

What is the carrier representative's email address?

Consent*

Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.

Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.

I agree

Home Replacement Cost Appraisal Analysis Form

Replacement Cost Factors - Pre-Appraisal

Replacement Cost Factors - Post-Appraisal

Replacement Cost Analysis

Appraisal Requirements

Appraisal Automation Options

Spencer Houldin

RiskRevu^TM Newsletter

Contact

Home Replacement Cost Appraisal Analysis Form

Replacement Cost Factors - Pre-Appraisal

Replacement Cost Factors - Post-Appraisal

Replacement Cost Analysis

Appraisal Requirements

Appraisal Automation Options

Spencer Houldin

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Contact

RiskRevu^TM Newsletter