Home Insurance Quote Worksheet

The property

Property address

Year built

Living area (sq ft)

Home type

How is it used?

Purchase date & price

Who lives there

Exterior walls (frame, brick, stucco…)

Roof material

Roof year / age

Foundation / basement

Garage (attached / detached / none, how many cars)

Systems, safety & current coverage

Roof last updated (year)

Plumbing last updated (year)

Electrical last updated (year)

Heating / cooling last updated (year)

Heating type

Dogs — breed(s), if any

Distance to fire station / hydrant

Mortgage company

Loan number (if known)

Current insurer

Current premium

Current dwelling limit

Renewal date

Claims in the last 5 years — what happened, when, amount paid

Valuables needing special cover — jewellery, art, collections, firearms (item and value)

Where should we send your quote?

First name

Last name

Email

Phone

This worksheet asks for dates of birth and driver's license details because carriers require them to prepare an accurate quote. Never enter a Social Security number — we will never ask for one here. Your information is used only to prepare your quote.

I agree to be contacted by phone, text, or email about this quote request. Consent is not a condition of purchase. Message/data rates may apply. See our Privacy Policy.

The property

Systems, safety & current coverage

Where should we send your quote?

Worksheet received.