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Home Evaluation Questionnaire
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1. What Year Was Your Home Built?
2. For Home Built Prior to 1940: In the event of a loss, would you select the reconstruction of your home to be of modern materials or exact replica materials?
Modern Materials
Exact Replica Materials
3. Which Type of Home Do You Have?
One family
Two family
Three family
Four family
4. Please Check Which Picture Most Resembles Your Home
One Story
Two Story/Three Story
Victorian
Split- Level/Tri-Level
Bi-Level/Two Levels
1.5 Story
Adobe
Townhome-End Unit
Townhome-Middle Unit
Contemporary
Do You Have a Garage or Carport?
Yes
No
Total Living Area, Excluding basement and attic
Foundation Type (Must add up to 100%):
Basement %
Crawl Space %
Slab %
Do you have a basement?
Yes
No
Is your basement a walkout?
Yes
No
What percentage of your basement is finished? %
If finished, finish style
Standard
Custom
Do You Have A
Wood deck
Composite deck
Porch
None
Is your porch...
Enclosed
Screened
Open
What is the square foot of your deck/porch?
Please select the Materials that describe those found in your home, for each category indicate the percentage of each type of material used in your home, total should be 100%:
Exterior Walls (should add up to 100%):
Brick (solid) %
Brick Veneer/Brick on Frame %
Concrete Block %
Stone (Solid) %
Stone Veneer/Stone on Frame %
Stucco on Block %
Stucco on Frame %
Wood Siding/Shakes %
Vinyl/Aluminum Siding %
Other: Please Specify and include %
Floor Finishes (should add up to 100%):
Hardwood %
Carpet %
Carpet over Hardwood %
Ceramic Tile %
Clay Tile %
Marble/Granite/Solid %
Slate/Brick/Flagstone %
Vinyl %
Other: Please Specify and include %
Please select the primary roofing material on your home
Asphalt Shingles
Wood Shingles
Clay/Concrete Tile
Metal(Tin, Steel)
Slate
Built-up Tar/Gravel
Other
If "other", please specify
How many kitchens are in your home?
Please indicate if any of your kitchens have the following special features (check all that apply)
Corian, Granite, or Marble Countertops
Center Island with Cabinents or Sink
6 or more total range top burners
More than one oven
Commercial Style Refrigerator
How many bathrooms are in your home?
Please check all that apply
Full (tub/shower, sink & toilet)
Corian, Granite or Marble
Third Choice
Double Sink
Half (sink & toilet):
Spa or Jacuzzi Tub
Bathtub and separate shower stall
Please indicate the number of these additional features in your home
Windows
Bay Windows
Bow Windows
Picture Windows
Doors & Fireplaces
Atrium/French Doors
Sliding Glass Doors
Fireplace
Please note any other features of your home that may cost more than $10,000 to replace in the event of a loss (i.e. Lanai, Sun Room, Greenhouse, etc.)
How many years have you lived at this residence?
