Year of updates:
        Electrical:     Plumbing:     Roof:     Heating: 

Type of heating system:  Gas   Oil   Electric
Count of wood burning stoves:  0    1   2 or More
Central Air:  Yes   No
Count of Fireplaces:  0   1   2   3 or more

If you have a garage, how many cars is it for?
      No Garage   1   1.5   2   2.5   3 or more

How many bathrooms:
      1   1.5   2   2.5   3   3.5   4   4.5   5 or more

Exterior Wall Type:  Vinyl   Aluminum   Brick   Wood/Log
Interior Wall Type:   Drywall   Plaster

Please indicate the type and percentage of flooring throughout the home:
        Carpet: %   Tile: %   Hardwood: %
        Carpet over hardwood: %   Vinyl: %

If you have any porches or wood decks, please list total square feet:
        Porch: sq. ft.     Deck: sq. ft.

Please list number of any special exterior features:
        Bay Windows:      Sliding Glass Doors:      Skylights:

Do you have a pool?  Yes   No
Do you have a hot tub?  Yes   No
Do you have a central alarm system?  Yes   No
Is there any business conducted on the premises?  Yes   No
Is this home going to be rented out to others?  Yes   No

If you've had any prior claims or losses, please describe below with dates:

Please list any additional structures on the property (sheds, outhouses, etc).  List dimensions and usage: