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		Home Quote * indicates required fields    *Name:   Address:   City:   State:   Zip:   Work Phone:   *Home Phone:   Email:   Year Home Built:   Total Living Area Square Footage:   Ground Floor Square Footage:   Number of Stories:   Is there a garage?:  Yes  No   If garage, number of cars:   Is there a carport?:  Yes  No   If carport, number of cars:   Type of Garage or Carport:  Attached  Detached  Built-in  Basement   Other Detached Structures:   Is the Home Built on a slope?:  Yes  No   If on a slope, degree:   Is there a basement?:  Yes  No   If yes, list finished & unfinished square footage:   Number of Bedrooms:   Number of Bathrooms:   Number of 3/4 bathrooms:   Number of 1/2 bathrooms:   Does the home have a formal dining room?:  Yes  No   Does the home have a laundry room?:  Yes  No   Other specialty rooms:   Does the home have a finished attic?:  Yes  No   Construction:  Wood  Masonry  Stucco   Construction:  Standard  Luxury  Custom   Foundation:  Closed  Open  Basement  Slab   Roof:  Composition  Wood Shake  Shingle  Clay Tile  Cement  Metal  Other   If other, list:   Heating:  Central  Forced Air  Furnace  Wall Heater   Does the home have central air conditioning?:  Yes  No   Fireplaces:   Does the home have a wood-burning stove?:  Yes  No   Does the home have a pellet stove?:  Yes  No   If yes, was it professional installed:  Yes  No   Does the home have a swimming pool?:  Yes  No   If yes, select additional details:  Fenced  Slide  Diving Board  Empty   Does the home have a hot tub?:  Yes  No   Total Porch square footage:   Total Deck square footage:   Have you remodeled? If yes, provide details:   Complete next section if home is over 20 yrs. old.:  You can move to Pets Section if home is less than 20 yrs.   Date plumbing last updated:   The last plumbing update was:  Partial  Complete  Home is less than 20 yrs old.   Date wiring last updated:   The last wiring updated was:  Partial  Complete  Home is less than 20 yrs old.   Is the home on circuit breakers?:  Yes  No  Home is less than 20 yrs old.   Last date roof replaced:   The roof replacement was:  Partial  Complete  Home is less than 20 yrs old.   Date heating last updated:   The last heating update was:  Partial  Complete  Home is less than 20 yrs old.   Is the heating checked annually by PG&E?:  Yes  No  Home is less than 20 yrs old.   Date exterior last painted:   Date interior last painted:   Is the home bolted to the foundation?:  Yes  No  Home is less than 20 yrs old.   Sheer-walled? (plywood nailed between studs):  Yes  No  Home is less than 20 yrs old.   Complete next section if you have pets.:  You can move to the Security Information section if you do not have pets.   Do you have dogs or exotic pets?:  Yes  No   If yes, provide number of animals, types & breeds.:   Do you have any ranch or farm animals?:  Yes  No   If yes, provide number of animals, types & breeds.:   Security Information:  Please complete the security information.   Does the home have a smoke detector?:  Yes  No   Does the home have a fire extinguisher?:  Yes  No   Does the home have dead bolts on outside doors?:  Yes  No   Does the home have internal sprinklers?:  Yes  No   If yes,:  In Closets  In Bathrooms   Does the home have a burgler alarm?:  Yes  No   If yes,:  Local  Central Station   Name, Address & Phone of Alarm Company:   Additional Coverage Needs:  Please list additional coverages needed.   Limit of Jewelry:   Limit of Furs:   Limit of Silverware:   Limit of Fine Art:   Limit of Home Office Business Property:   Limit of Business Property Away from Home:   Do you have a housekeeper or gardener?:  Yes  No   If yes, number of hours worked:   Prior Losses:  Please list all prior losses below.   Date of Loss, Type of Loss, Amount Paid, Details:   Personal Information:  Complete your personal information below.   Name:   Date of Birth:   Occupation:   Employer & Years Employed:   Name:   Date of Birth:   Occupation:   Employer & Years Employed:   Current Carrier, Expiration Date & Premium:   How did you hear about us?: