| Contact Can Be Reached At: |
| Name: |
Shopper, Jane |
Home: (505) 555-1234 |
| Address 1: |
1234 Main Street |
Work: (505) 555-1234 |
| City/St/Zip: |
Anytown, CO 80206 |
Fax: |
| County: |
Denver |
Email:janeshopper@netquote.com |
| Address 2: |
Contact Time:Anytime |
| City/St/Zip: |
Respond Time: Within 24 Hours |
| County: |
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Owner/Co-Owner Information:
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| Owner's Name:Shopper, Jane |
Owner's Date of Birth:10/20/1972 |
| Owner's Age: |
36 |
Owner's Gender : Female |
| Owner's SSN: |
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Owner's Self-Credit Rating : Good |
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| Continuously Insured for the past 58 Months With State Farm |
| Multi-Policy Discount :Yes |
Expires:12/31/2009 |
| Current Residence :Own |
At this Address Since :01/02/2005 |
| Owner Status :Own |
Occupied By Applicant :Yes |
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Resident To Be Quoted: |
| Address:12345 Main Street Denver, CO 80206 |
| Dwelling Type:Single Family Home |
Dwelling Coverage:$400,000 |
Deductible:$1,000 |
| Personal Liability :$300,000 |
Attack Breed (Canine) :No |
Bus/Farming on Premise:No |
| Resident Type:Primary |
Year Built:2000 |
Design:2 story |
| No of Bedrooms :4 |
No of Bathrooms :3 |
Total Rooms :10 |
| No of Units : |
Exterior Wall:Aluminum or Siding |
Square Feet:3,500 |
| Foundation:Cement |
Fireplaces/Wood stove:1 |
Roof:Composite Shingle |
| Roof Age :5-10 Years |
Garage:3 car attached |
Wiring:Copper |
Service Panel:Circuit Breaker |
Heating:Forced Air |
Fire Hydrant:Within 1000 Ft. |
| Location:Inside City Limits |
Proximity to Water:Not Applicable |
Central Air:Yes |
| Dead Bolts:Yes |
Smoke Detectors:Yes |
Indoor Fire Sprinkler :No |
| Fire Alarm :Yes |
Fire Extinguisher:Yes |
Burglar Alarm:Unmonitored |
| Covered Patio/Deck:No |
Uncovered Patio/Deck:Yes |
Swimming Pool:No |
| Tennis Court :No |
Trampoline:No |
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Claim Information: |
| No claims for past 3 years |
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Questions And Comments: |
| No comments provided |
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