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Home Insurance FAQ
Full Name
*
Address
*
Town
*
State
*
Zip Code
*
Business Phone
*
Home Phone
*
Best Time to Call
E-mail Address
*
Occupation
*
Employer
*
Social Security #
*
Home Information
Year built
How long at present address
years
months
Number of claims in last 3 years
Sq. footage of home
(excluding garage and basement)
Structure Information
Type
1 Story
1 1/2 Story
2 Story
Split Level
Bi-Level
Other
Construction
Frame or Stucco
Masonry or Veneer
Masonry
Other
Roof
Asphalt Shingle
Wood Shingle
Tile or Slate
Other
Age of roof
years
Foundation
Basement
Crawl Space
Slab
Other
Garage
1 Car
2 Car
3 Car
4 Car
None
Attached
Detached
Basement
Built-in
Car Port
None
Features
Bathrooms:
full
half
Basement
None
Finished
Unfinished
Sq.Ft
Deck Sq.Ft.
Porch Sq.Ft.
Screened Patio Sq.Ft.
Fireplaces:
Chimneys
Hearths
Additional Features
Heating System
None
Electric
Gas
Oil
Propane
Solar
Other
Central Air
Central Vac
Security Alarm
None
Monitored
Not Monitored
Fire Alarm
None
Monitored
Not Monitored
Smoke Detector
Current Homeowner's Insurance Company
(not agency)
Company Name
Policy Exp. Date
Amount Insured for
$
Premium
$
Term
6 months
1 year
other
Additional Comments:
How did you hear about NBP?
Select one
Browsing Internet
Commercial Mortgage Insight
Multifamily Executive
Word of Mouth - Please specify.
Other - Please specify.