Property Address:

Street Address:
 

Town or City:
 

Year of construction (approx):
 

Type of Construction:
  Wood Masonry Apartment Complex

Approx. square footage of home:
  less than 1500 sq feet 1500-2000 sq. feet 2000-3000 sq feet over 3000 square feet

Style of Home:
  Ranch Slit level Gambrel Cottage Contemporary Colonial Raised Ranch Other

Dollar amount of contents (approx):
(estimate the amount it would cost to replace furniture, fixtures, appliances, and general household living items)

Do you have any expensive jewelry, furs, camera equipment, antiques, etc., that need additional coverage?
Yes      No

Have you ever had any homeowners claims, or has the home ever sustained any extensive damage?
No                   Yes

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