Homeowner’s Rewrite Questionnaire

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Contact Us

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Name

First Last

Date

MM slash DD slash YYYY

House Information

Year Built

Please enter a number less than or equal to 2045.

Purchase Date

MM slash DD slash YYYY

Sq Feet (Excluding Basement)

Please enter a number less than or equal to 100000.00.

Have you done any renovations that you haven’t already discussed with us?

Yes

If yes, please describe:

Do you have a Basement?

Yes

If yes, is it Full or Partial?

Full

Partial

If partial, % of crawl space and/or slab:

Is it Below Grade or Walk Out?

Below Grade

Walkout

% finished

Do you have a Garage?

Yes

# of cars it holds

Type

Do you have a Swimming Pool?

Yes

If yes, In-ground or Above Ground?

In-Ground

Above-Gound

Is it Fenced?

Yes

Do you have a diving board?

Yes

If yes, how high is it?

Is there a Sliding Board?

Yes

Systems Information

Year roof last replaced

Roof Shape

Shingle Type

Alternative/supplemental heat sources such as a wood/coal/pellet stove?

Yes

Heat Type

Age of Heater (Years)

Please enter a number less than or equal to 300.

If Oil: Where is tank located?

When was the burner last replaced? (Year)

Please enter a number less than or equal to 300.

If flat roof, is it Rubber or Tar & Gravel?

Yes

Do you have a sump pump?

Yes

If yes, does it have a backup?

Yes

If yes, type:

Protective Devices & Information

Do you have a Burglar Alarm?

Yes

If yes, is it:

Local

Central Station

Do you have Dead Bolts?

Yes

Do you have Sprinklers?

Yes

Do you have a Fire Alarm?

Yes

If yes, is it:

Local

Central Station

Do you have Smoke Detectors?

Yes

If yes, are they:

Hard-wired

Battery operated

Nearest Fire Hydrant (Feet)

How close is the nearest Fire Station? (Miles)

Coverage Information

Do you have any valuable items (ex: jewelry, furs, guns, fine art, or collectibles) that we don’t currently insure?

Miscellaneous Information

Do you have a trampoline?

Yes

If yes, is it netted?

Yes

List any pets or exotic animals (include breed & bite history)

Do you own any other properties that we don’t currently insure?

Yes

If yes, please list:

If yes, who insures those properties?

Any properties titled in a trust or LLC?

Do you own any trailers, watercrafts or jet skis, recreational vehicles, snowmobiles, ATVs, or golf carts?

Yes

If yes, describe:

Is any part of your home available for rent (including vacation rental or home sharing/swapping)?

Yes

Do you have a home based business or a hobby that generates income?

Yes

Do you conduct any type of business on the premises

Yes

Do you have any professional tools or equipment at your home?

Yes

Do you baby-sit or operate a child daycare in your home?

Yes

Any members of your household not related to you?

Yes

If you have children, are any of them full time college students?

Yes

Any member of your household recently married, moved out, separated, or divorced?

Yes

Spencer Insurance Agency, Inc., an independent insurance agency, provides life insurance, disability insurance, auto insurance, home insurance, business insurance, and umbrella coverage.

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115 West Ave, Suite 108
PO Box 54
Jenkintown, PA 19046-0054
(215) 885-2200
info@spencerinsurance.com
(215) 887-9538