Royce & Rosenkrans Insurance

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Royce & Rosenkrans Secure Home Owner's Insurance, Home Owner's Information Form

Home Owner's Information

Name

Mailing Address

Mailing City

Mailing State

Mailing Zip

Home Telephone Number

Cell Phone Number

E-mail Address

Current Coverage

Current Provider

Policy Number

Amount of Coverage

Expiration Date

Do you have auto insurance?

Yes

Pet(s) Owned

	Type	Breed	Age	Quantity
PetRemove
Add a Pet

Claims History
(Write out as much as you can about all the claims you've made)

Royce & Rosenkrans Secure Home Owner's Insurance Property Information Form
Property Information
Is the address above the property's address as well?	No
Property Address
Property's Address
Property's City
Property's State
Property's Zip
Year Built
Framing Type
Attic
Number of Stories
Single/Multi-Family
Number of Multi-Family Units
Heating / A.C. Details (Describe)
Plumbing Type
When was the Plumbing Last Updated?
Electrical Type
When was the Electrical Last Updated
Deck (sq ft)
Porch
Porch (sq ft)
Basement
Roof Type
Last Time the Roof was Updated
Garage/Carport
Siding
Trampoline
Swimming Pool
Pool Accessories (Check all that apply)	Slide Diving Board
Pool Area Fenced In?
Fireplace(s) (Check all that apply and provide details)	Built In Free Standing Wood Coal/Other
Other Structures (Describe)
more room