Detailed Homeowners Quote Questionnaire Homeowners Insurance Checklist Thomas Insurance Advisors Homeowners Insurance Checklist last edited 02.26.18 Step 1 of 5 20% General InformationName:* First Last Phone Number:*Current Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How long have you lived at your current address?*Previous Address: IF AT YOUR CURRENT ADDRESS FOR LESS THAN 3 YEARS Street Address Address Line 2 City State / Province / Region ZIP / Postal Code If you have dog(s), what breed(s)?*Mark "N/A" if this does not apply. Your HomeCurrent Market Value of your home (An estimate is fine):*Number of stories*123Is there a basement?*YesNoIf you do have a basement, is it a walk out?*YesNoN/AWhat percentage of the basement is finished?*Mark N/A if you do not have a basement. Exterior of the HomeWhat percentage is 'siding'?*Siding or wall cladding is the protective material attached to the exterior side of a wall of a house or other building.What percentage is 'brick'?*Last year roof was updated:*Any wooden decks?*YesNoIf you have a wooden deck(s), what are the square footage for each?*Mark "N/A" if this does not apply.Do you have a swimming pool at your home?*YesNo Interior of the HomeWhat kind of alarm system do you have in your home?*Mark "N/A" if this does not apply.How many fireplaces do you have?*N/A123Are there circuit breakers?*YesNoKnob & tube/aluminum wiring?*YesNoOther Items to be coveredDo you need earthquake coverage?*YesNoI don't knowDo you need jewelry coverage?*YesNoIf you do need jewelry coverage, how much ($) is needed?*Mark "N/A" if this does not apply. Thank you for your time!Thomas Insurance Advisors would like to thank you for completing the homeowners questionnaire. If you have additional questions, concerns or feel you need to supply additional information; then please use the space below.