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LIST THE TYPE |
LIST THE AGE |
LIST THE CONDITION |
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ROOF?
Is the roof Flat?
YES
NO |
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Main Heating Source? Do you have a furnace?
YES
NO
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Plumbing? Copper, Plastic pipes?
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Do you have Circuit Breakers or Fuses? |
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Do you have a Wood Stove,Fire Place, Pellet Stove or Wood Furnace?
YES
NO
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Chimney must be flue
lined or metal; in separate chimney from furnace. |
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Smoke Detectors?
YES
NODeadbolts?
YES
NO
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Fire extinguishers?
YES
NO |
Alarm system with reporting (Central Station)
YES
NO
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Detectors are
required; please install them if you do not currently have them. A 2%
discount will apply! |
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Do you have outbuildings? |
GARAGE
YES
NO
Used
for?______________ |
SHED
YES
NO
Used
for?______________ |
BARN
OR OTHER BLDG?
Describe
__________________ |
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Recreational Items? Do you have any of the following? |
Swing Set / Trampoline
Swimming Pool |
Boats or Docks |
Other, Please specify.
______________________ |
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Pets? YES
NO
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If DOG specify breed. |
_________________ |
Aggressive?
YES
NO
Bite history?
YES
NO |
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Do you have overhanging trees/limbs that could fall &
damage your dwelling, etc.? |
YES
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NO |
Describe______________________________________ |
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Do you have a pool, pond, creek or other water
exposure? |
YES |
NO |
Describe______________________________________ |
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Do you use portable heaters space heater/kerosene
heater? |
YES
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NO |
Describe______________________________________ |
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Please provide 911
address & directions if rural location. All homes must have visible house
numbers in case of emergency.
_____________________________________________________
____________________________________________
____________________________________________
Questions/Comments_____________________________
ญญญญญญญญญญญญ________________________________________________
____________________________________________ |
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Is dwelling owner occupied?
YES
NO
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