Mountain Home Coverage Review

Share what you’re comfortable sharing. The more we know, the more we can do upfront. If you don’t know something, leave it blank and we can go from there.

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Your Name *

First

Last

Property Address

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

How would you describe the overall condition of the property? *Select an optionExcellent / recently updatedGood / well maintainedAverageFair / some repairs or updates neededMajor renovation or repairs neededNot sure

dwelling Renovations have?

Will there be a mortgage on the property?Select an optionYesNoNot sure yet

Lender / Mortgage Company

Optional. Please do not enter a loan number or full mortgagee clause.

Email *

Phone

Mailing Address, if different from Property Address

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Leave blank if your mailing address is the same as the property address.

Property UseSelect an optionPrimary residenceSecondary / vacation homeLong-term rentalShort-term rentalSeasonal rentalVacantUnder renovationMixed use / not sure

Ownership Type Select an optionIndividualMarried / joint ownershipTrustLLCEstateOther

Co-Applicant / Additional Named Insured

First

Last

If another person will be listed on the policy, enter their full legal name here. Leave blank if none.

Will this property ever be rented?Select an optionNo — personal use onlyYes — 30+ day rentals onlyYes — short-term / vacation rentalsBoth long-term and short-termNot sure yet

This helps us route your request to the right insurance markets.

What do you need help with?Select an optionNew purchaseCurrent policy reviewRenewal coming upNon-renewal notice receivedFAIR Plan quoteDIC / companion policy quoteExisting FAIR Plan + DIC reviewLender / escrow requirementSecond opinionNot sure — need guidance

Purchase Price, if applicable

Desired Closing / Effective Date

Date

Time

MLS / Property Listing URL

Year Built

Approximate Living Area (sq ft)

Bedrooms

Baths

Number of StoriesSelect an optionNot sure11.5234+

Exterior / Construction TypeSelect an optionNot sureWood frame / sidingStuccoFiber cementMasonryLogMixed / other

Garage / CarportSelect an optionNot sureNone1-car2-car3+ carCarportDetached garageOther

Primary Heating TypeSelect an optionNot sureForced air / furnaceBoiler / hydronicHeat pumpElectricWall / floor heaterOther

Roof MaterialSelect an optionNot sureComposition / asphalt shingleMetalTileWood shake / shingleOther

Please provide the current roof material, even if online property listings show older information.

Approximate Roof Replacement Year

Please provide the approximate replacement year for the current roof, even if online property listings show older information.

Fireplace / Wood-Burning ApplianceSelect an optionNoneGas fireplaceWood-burning fireplaceFireplace insertFreestanding wood stovePellet stoveMore than one / combinationNot sure

Please briefly describe the fireplaces or wood-burning appliances

A short description is enough.

Major Renovations or Property Updates

Any property or liability claims in the past 6 years?Select an optionNoYesNot sure

Briefly describe the claim(s)

A short summary is enough—for example, the approximate date, type of claim, and whether repairs are complete.

Which of these does the property have?

• Centrally monitored fire alarm
• Centrally monitored burglar alarm
• Local smoke/fire alarms only
• Interior fire sprinklers
• None
• Not sure

About how much personal property would you want insured?Select an optionUnder $100,000$100,000–$250,000$250,000–$500,000$500,000+Not sure — help me determine this

This is your current preference, not a final Coverage C limit. We can help you refine it.

Do you have an existing dwelling limit, replacement-cost estimate, appraisal, or prior policy you’d like us to consider?Select an optionYesNoNot sure

If Yes, add brief details below. You may also use the Secure Upload option on this page to share a document.

Existing dwelling limit / replacement-cost reference

Optional. Enter an amount or short description; do not guess if you do not know.

Anything else we should know?

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