Home Questionnaire Name as shown in your letter/email* First Last Policy Number as shown in your letter/email*Have you completed any improvements or renovations to your home since you last reviewed the coverage amounts on your policy?* Yes No Is the name on your policy the same as that shown on your deed (Example: Trusts)?* Yes No Do you have a Mortgage or other line of credit secured with your home?* Yes No List Mortgagee(s)*Are you aware all home, condominium, and renters policies contain a sub limit for theft of guns, jewelry, cash, and other items?* Yes No Do you own any guns, jewelry, cash, or related items?* Yes No List related items*Do you own any animals (both pets and farm animals)?* Yes No Number of animals, type, and breed*Do you own any additional property?* Yes No Do you own any vacant land?* Yes No Do you rent any portion of your home to others (VRBO, AirBNB, etc.)* Yes No Does your home have a monitored Fire Alarm System* Yes No Does your home have a monitored Burglar Alarm System* Yes No Does your home have a Nest, Phone-Controlled Thermostat, etc.* Yes No Please provide details*Your homeowner’s policy DOES NOT provide flood coverage. Would you be interested in a flood insurance quotation? You can still purchase a flood policy even if you are in a low-risk zone.* Yes No We also offer the following products. Check all those that apply to you Secondary or Seasonal Homes or Cabins Personal Umbrella Liability Life Insurance Health Insurance - Medicare Products Disability Insurance Flood Insurance Snowmobile/Boat/UTV/ATV Insurance Recreational Trailer/RV Insurance Is your Auto Insurance Currently through Cordova Agency?* Yes No FileAccepted file types: jpg, gif, png, pdf, Max. file size: 512 MB. Signature*Date* MM slash DD slash YYYY Phone*Email*
