Stradling & Spece Insurance Agency, Inc.

Homeowners Insurance Quote


*	Name:
	Address:
	City:
	State:	Zip:
	Social Security #:
*	Phone:
	Fax:
	E-mail:
	Current Insurance Carrier:
	Expiration Date:

Property Location:
Dwelling Amount:
Liability Amount:
Deductible Amount:
Renewal/Effective Date:

Living Area Square Footage:
Year Built:
Type of Construction:	Brick Frame Log cabin Other:
Update Information:	Plumbing -	Year Completed
	Heating -	Year Completed
	Electric -	Year Completed
	Roof -	Year Completed	Flat
			Peaked
Circuit Breakers?:	Yes No

Check appropriate boxes:

Kitchen
Dining Room
Living Room
Den/Study
Family Room
Dinette
Bedrooms    how many
Full Baths    how many
Half Baths   how many

Porch         EnclosedOpen
Attic           FinishedUnfinished
Basement  FinishedUnfinished
Garage AttatchedUnattatched
      No. of Cars

Central Air
Aluminum Siding
Fire Place InOut

High Value Items
Jewelry:	$
Furs:	$
Silverware:	$
Fine Arts:	$
Other:		$

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