Have your producers use this questionnaire from Jack Fries to garner needed information from Homeowners prospects:
HOMEOWNERS INSURANCE QUESTIONNAIRE
Producer: ______________________________________ Date: ___________________
INSURED Name _____________________________ Phone __________________
Address _______________________________________________________
City ______________________ State _____ Zip ____________________
Occupation ____________________________________________________
PRESENT HOME Homeowners Carrier _________________ Exp. Date_____________
LIMITS
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
Additions/Alterations
'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 ____________________
­ LIMITS
Liability _________ Deductible ______________ Premium ___________
Guaranteed Replacement Home ____ Contents
'All Risk' Contents
Sewer Backup ____ Other
REPLACEMENT Number of families Year Built _________ Sq. Ft _________
COMPUTATION
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 __________