What is your first name?
What is your last name?
What is your email address?
What is the location address of the home we are evaluating?
Has this home been renovated since it was originally built?
Select the features of your home that have been updated.
What year was the electrical updated? (YYYY)
What year was the plumbing updated? (YYYY)
What year was the heating system updated? (YYYY)
What year was the roof updated? (YYYY)
What year were the windows updated? (YYYY)
What other updates have been done to your home?
Is this home listed on the National Register of Historic Homes? (www.nps.gov)
What is the square footage of the home's living area? (Do not include a finished basement.)
What year was this home built?
Please select the other features of this home. (Select all that apply)
What type of garage does this home have?
How many bays does the garage have?
What is the square footage of the garage?
What type of basement / crawl space does this home have?
What year was the basement finished?
What is the square footage of the finished basement?
What is the square footage of the unfinished basement?
What type of deck does this home have?
What year was the deck built?
What is the square footage of the deck?
What type of porch does this home have?
What year was the porch built?
What is the square footage of the porch?
Please select any other defined spaces at this home. (Select all that apply)
Structure Details
What is this home's architectural style?
What is the construction type of this home?
Select the option that most accurately describes this home's construction quality.
What is the physical shape of this home?
What is the primary exterior of this home?
What is the primary roof cover of this home?
Describe this home's locale. (Select all that apply)
Additional Information
How many rooms does this home have?
How many bedrooms does this home have?
How many bathrooms does this home have?
Please select the heating type for this home.
Please select the heating fuel type for this home.
Please select the air conditioning type for this home.
How many fireplaces does this home have?
What is this home's roof configuration?
What is this home's roof pitch?
What is this home's foundation type?
How many stories does this home have?
Do you have any other structures on your property?
How many buildings are on the property?
Other Structures
Please select the type of other structure you have on this property.
What year was this structure built?
What is the square footage of this structure?
What is the construction quality of this structure?
What is the condition of this structure?
What is the construction type of the pool?
What is the construction type of this structure?
What is this structure's primary exterior?
What is this structure's primary roof cover?
Is there a second other structure on the property?
Please select the type of other structure you have on this property.
What year was this structure built?
What is the square footage of this structure?
What is the construction quality of this structure?
What is the condition of this structure?
What is the construction type of the pool?
What is the construction type of this structure?
What is this structure's primary exterior?
What is this structure's primary roof cover?
Pictures and Comments
Please upload current pictures of your home and other structures (maximum 10 photos)
Please enter any additional comments about the specific characteristics of your home in the space below.
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.
