Homeowners Quote Request - VTC Insurance Group

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Insured Name

Insured SSN

Insured DOB

Spouse Name

Spouse SSN

Spouse DOB

Location Address

Previous Address (if moved in the last 2 years)

Phone

Phone Type

Email

Insured Occupation

Insured Education Level

Insured Group Discount (Alumni, AARP, etc.)

Spouse Occupation

Spouse Education Level

Spouse Group Discount (Alumni, AARP, etc.)

Current Insurance Company

Policy Number

Expiration Date

Premium

Deductible

Liability Limits

Dwelling Amount

Length of Time with Carrier

Mortgage

Claims

Coverage Type

If Rental, $ Value of Contents

Current Market Value

Year Built

Occupancy Date

Roof Update

Electric Update

Plumbing Update

Heat Update

Exterior Wall Material

# of Stories

# of Full Baths

# of Half Baths

Total Floor Sq Ft

Foundation Type

% of Basement Finished

Walkout

# of Fireplaces

Type of Fireplace

Wood Burning Stove

Central A/C

Pets

Bite History

Breeds

Garage

# of Cars

Separate Garage Heat

Porch

Porch Sq Feet

Deck

Deck Sq Feet

Swimming Pool

Fenced

Diving Board

Slide

Hot Tub / Jacuzzi

Trampoline

If yes, is trampoline netted?

Other Structures

Description

Smoke Detector

Central Alarm

Built-In Generator

Multi-Policy Discount?

Fire Extinguisher

Non-Smoker

Deadbolts

Back-Up Sump Pump

Responding Fire Department

Distance to Hydrant

Distance to Station

Scheduled Property / RV / Watercraft

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