ࡱ>    !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntryZ O2 rVCONTENTS *CompObjVSPELLING(_ No___ Watercraft? Yes___ No___ Snowmobiles? Yes___ No_ ATV s? Yes___ No___ Auto Insurance Carrier_____________________________ _ Birth Dates__________________ Current Address____________________________________ New aAddres;DF24npz| v x   ^ `  &(\^xz*,.02468:<>(2"'( ) @S p:> "!"  "  77 " " tt>>(7Times New Roman " " "XXddddSamsung ML-1740 Series odXXPRIVp dCourier NewHCHNKWKS *TEXTTEXT>FDPPFDPPFDPCFDPCSTSHSTSHSTSHSTSH2SYIDSYIDPSGP SGP dINK INK hBTEPPLC lBTECPLC FONTFONT<STRSPLC :PRNTWNPRFRAMFRAM'TITLTITLR(DOP DOP d( Homeowners Quote Sheet Date______ Phone #__________ Name____________________________________________ Email Address____________________________ Discount Group/Employer_____________ Birth Dates__________________ Current Address___________________________________ New Address/Closing date (if new purchase)________________________________________ Mortgage Company__________________________________ Escrowed? Yes___ No___ Dwelling Coverage/Purchase Price $_____________ Construction: Frame_____ Masonry_ Siding: Wood____ Alum____ Vinyl____ # of Stories______ Roof type________ Style of home____________ Sq. Footage _____________ Year of Construction_______ #Bathrooms: Full____ Half____ Fireplace or Woodstove? Yes___ No___ Central Air Conditioning? Yes___ No___ Garage? Yes___ No___ # of cars___ Porch/Sq. Feet______ Deck/ Sq. Feet_____ Balcony/ Sq. Feet____ Pole Barn/Other Structures? Yes___ No___ Size and Value_______ Year of Updates: Wiring_____ Roof_____ Heating_____ Plumbing_____ Smoke Detectors? Yes___ No___ Fire Extinguisher? Yes___ No___ Smokers? Yes___ No___ Dead Bolt Locks? Yes___ No___ Central Station Alarm? Yes___ No___ Responding Fire Dept./ Township___________ Miles Away_________ Fire Hydrant__________ Ft. Away___________ Any Animals/Kind? Yes___ No___ Trampoline? Yes___ No___ Hot Tub/Locked? Yes___ No___ Swimming Pool/Fenced? Yes___ No___ Any Claims in the last 3 years? Yes___ No___ Type of loss/ Date/ Amount Paid__________ Deductible: 250____ 500_____ 750____ 1000____ 2500____ Scheduled Jewelry? Yes__(winspoolSamsung ML-1740 SeriesUSB001F"\""V"$c"` "``""A."@"\""V"$c"` "``"."Untitled"p"pp (" Fenced? Yes___ No___ Any Claims in the last 3 years? Yes___ No___ Type of loss/ Date/ Amount Paid__________ Deductible: 250____ 500_____ 750____ 1000____ 2500____ Scheduled Jewelry? Yes__ Z O2Quill96 Story Group Class9qyyy