Greetings! In order to provide an accurate rating for a Dwelling insurance quote, please answer the following questions: Named Insured(s)Name/s (as shown on deed):(Required)FirstLast Add RemoveDate of Birth:(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Location to be Insured If the home is deeded to a Trust, please provide the name of the trust: Trustee name(s):FirstLast Add RemoveBeneficiary: Please indicate if trustee and/or beneficiary resides at the property: Years at insured location? If less than 3, what is prior address? Purchase Price? Coverage Effective Date: MM slash DD slash YYYY Preferred deductible ($500/1,000/2,500/etc)Do you currently have a Homeowner policy? If not, why? (Nonpayment, underwriting, new home purchase?) Is this a long or short term rental? How many weeks per year? (Explain): Do you use a realtor or rental platform such as AirBnb, Vrbo, etc? (Describe): Property DetailsPrimary, secondary, or rental home? Type of home (single family, condo, mobile home, etc): Is the home visible to neighbors?YesNoIs the property located within 300 feet of a commercial building?YesNoYear Built? # of Stories? Square Footage: Basement Finished? Construction? (frame, brick, etc): Foundation? (Basement/Slab/Crawl Space/Piers/Stilts): Exterior Walls? (Wood/Clap/Vinyl/Shingles): Roof? (3‐tab asphalt, architectural, wood, slate, etc): Bay/Bow/Specialty windows? How many? French doors/sliding glass? How many? Kitchen & Bath (How many & quality?): Basic / Builders Grade / Semi Custom / Custom / Designer Kitchen(s): Full Bath(s): Half Bath(s): ¾ Bath(s): Garage? (Attached/Detached? # of cars) Deck? (sq ft): Porch? (sq ft): Detached Structures (Describe): If the home is older than 20 years, when (or best estimate) was the last time the following were replaced/updated?Roof? (what year & details – complete/partial?): Heating System? (what year & details – complete/partial?): Wiring? (what year & details – complete/partial?): Plumbing? (what year & details – complete/partial?): Do you have a centrally monitored alarm or a Smart alarm? (Type ‐ burglar, fire, water, freeze etc?)Heat type (electric, propane, oil, gas/hot air or hot water): If oil/propane heatistank indoors or outdoors, and aboveground or buried? Age of tank? Underwriting QuestionsDo you have a wood or coal stove? (Describe): Any smokers in the household?: Do you have a whole house generator?: Do you have an automatic water shut off?: Have you had any insurance claims in the past five years? (Please explain date of loss, what happened, if claim closed, and amount paid): Is the house under construction/renovation? (Please provide details): Any foreclosure, repossession, or bankruptcies in the past 5 yrs?: Do you own a trampoline?: Is there a fully enclosed safety net?: Does the house have a pool?: Is there a diving board/rocks or slide?: Do you allow animals?: If yes, tenant has what type/breed, name & age?: Bite history/Aggression? Are there any weapons in the home?: Do you own or occupy any other property?: What is your occupation?: Is there any business conducted from home?: Do customers come on the property?: Do you have insurance for your business?: Billing QuestionsIs there a mortgage on the property? If yes, how many? Mortgagee 1: Mortgagee 2: Mortgagee 3: Is premium paid by escrow or insured? If insured, bill by mail or EFT? Do you prefer policy documents and billing by US mail or email?: How did you hear about this agency?: If you were referred, will you please let us know by whom so we may thank them?: *Please be sure to answer all applicable questionsto help ensure accurate rating. If you have a current policy and would provide us with a copy it will help expedite the quoting process. Thank you for choosing Almeida & Carlson Insurance Agency for your insurance needs!CAPTCHA