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Contents Insured For: Current Ded: Premium Amount: Policy Term: Any Claim in Last 3 Years? General Information About Your Home Will you or do you live on this property: How much coverage do you want on your personal property: How much personal liability: $100,000 $300,000 $500,000 $1,000,000 Deductible: $500 $750 $1,000 $2,000 Number of Units: Number of Stories: Is there a 24-hour door man: Are there elevators: Year Built:
Approximate Square Feet: Have you reported any claims or losses to your insurance company within the last 5 years: Type of Construction: brick wood frame cinder block other Roof Type: composite shingle tile wood shingle other Age of Roof: Burglar Alarm: Heating System: forced air electric boiler oil propane # of Fireplaces: What floor do you live on: Number of bathrooms: Additional Information Any business conducted in home?: No Yes If yes, please describe List values of any jewelry, furs, or specialty items: List Pets & Breeds: Additional Comments: Please give any additional comments or questions
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