Homeowners Questionnaire


1 Verified Reviews - 5 of 5.0

Have your producers use this questionnaire from Jack Fries to garner needed information from Homeowners prospects:





Producer: ______________________________________      Date: ___________________


INSURED       Name _____________________________      Phone __________________


                     Address _______________________________________________________


                     City ______________________ State _____    Zip ____________________


                     Occupation ____________________________________________________



PRESENT HOME     Homeowners Carrier _________________ Exp. Date_____________


        Dwelling _________________ Year Built _____________           Brick or       Frame

        Additional Structures _______________ Liab. ___________

        Contents _________________________ Medical ________

        Loss of Use _______________________ Deductible ______

        Prior Claims _______________________ Premium _______


        Credits - Alarm, etc.________________________________


        Guaranteed Replacement:   

                      Home                Contents


                      'All Risk' Contents

                      Theft Ext.           Sewer Backup

                      Subsidence         Earthquake

                      Extended Liability


        Scheduled Items Limits:

         Jewelry             Furs       

         Fine Arts           (Breakage)       

         Silver                Coins        Stamps       

         Guns                Boats        Computers ______

         Photo Equipment         



COMMENTS       Are your autos insured with the same company? ____________


                          Expiration Date: _______________

RECOMMENDED     Dwelling _________  Company ____________________


      Liability _________  Deductible ______________ Premium ___________


      Guaranteed Replacement            Home    ____  Contents

                                                      'All Risk' Contents


                                                      Sewer Backup  ____ Other


REPLACEMENT       Number of families        Year Built _________ Sq. Ft _________


                                     Brick      Frame


                               Garage      Cars       Brick       Frame       Attached


                               Balcony           Porch      Deck          Sq. Ft.


                               # of Fireplaces ____   # of Chimneys     


                                    Inside        Outside


                               # of Baths Full      1/2     


                               Basement?      Finished?     


                               Central Air? ___


                               Wiring: -- Year Update: _________


                               Heating      Construction Type I, II, III, IV

                    Plumbing: -- Year Update: _______


                    Roof: -- Year Update: ___________


                    Built-ins:      Stove      Refrigerator      Dishwasher


                                       Washer      Dryer      Sauna      Hot Tub


                    Replacement value _______  Market Value __________

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