Type of Home Year Built Square Footage Construction Type Primary Heating Foundation Bedrooms Roof Type Bathrooms Roof Age Stories Garage Type Is your home located in a flood plain? Security System Municipal Location Fire Alarm Do you have any of the following breeds of dogs: Chow, Doberman, German Shepherd, Pit Bull, Rottweiler, Wolf Hybrid, or a mix of these? Approximate Replacement Cost of Dwelling (not including land) Personal Liability Coverage Desired Desired Deductible Will this insurance replace an existing policy? Have you reported any claims or losses to your insurance company within the past 5 years? Credit Rating When would you like this policy to start?

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