Basement: 
if yes % finished:   & % unfinished:  

Total square feet of living area:

                    Length:    x   Width:   

Exterior walls construction:

Interior Wall coverings:
Such as paint/wallpaper :

Ceilings Construction:

Specialty Ceilings Such as Tin, Mirrored, Wood, etc: % 

Flooring: Hardwood: %
  Vinyl: % 
Wall-to-Wall: %

Carpet: % 

Ceramic Tile: % 
     Parquet: % 
Slate: % 
Stone: % 

Interior Items: 

Kitchen:                      Full Baths:                Half Baths:

French Doors:      Sliding Glass Doors:                Fireplaces:

Distance to Fire Hydrant:                      Distance to Fire Department:

Number of Pets in Household:     Number of Dogs:       Cats:

Breed of Dogs:

Specialty Windows (such as bay, bow, picture):

Any specialty wall coverings such as tongue-in-groove

Porches:   sq.ft.              Decks: sq.ft.          Patios: sq.ft.

Roofing last updated:                   Plumbing/Electrical last updated:

Any other additions such as swimming pools, gazebos, etc.):

Claims History:
(Any homeowners loss reported to your insurance carrier in the past 5 yrs)
 

Please Note:
Insurance coverage cannot be bound without a written binder from our office.