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Name*

Email*

Date of Birth (DOB)*

Address*

Purchased Year*

Square footage*

Type of home*

Roof type & year updated*

Siding material*

Number of bathrooms & bedrooms*

Garage type*AttachedDetachedNone

Basement*FinishedUnfinishedNone

Any updates*

Current insurance company

Desired deductible*

Any recent claims*

Occupancy*PrimarySecondaryRentalVacant