FILL OUT THE FOLLOWING AND SUBMIT FOR A HOME QUOTE
If yes, list carrier and # of years continuous.
DISTANCE TO FIRE STATION:
1. Is Risk in city limits:
2. Is Risk within 1000 feet of a fire hydrant?
3. Is Risk vacant or unoccupied?
4. Is Risk occupied by more than one family?
5. Is business conducted in Risk?
6. Any previous losses on any properties in the past five years?
7. Any previous fire losses?
8. Has risk been cancelled, nonrenewed, or declined by another company?
9. Is there a wood buring stove located in the risk?
If yes, is the stove correctly installed?
10. Have you filed bankruptcy in the last five years?
11. Any animals?
If yes, please list:
12. Is there a swimming pool on the premises?
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