Full Application

Homeowners Insurance Application

The complete homeowners application, in seven sections. Fill in what you know — you don't have to finish every field to send it, and we'll follow up on anything missing.

844-967-5247josh@contractorschoiceagency.com
1.

Applicant and Policy Information

Please provide legal names exactly as they should appear on the policy.

APPLICANT INFORMATION
EMPLOYMENT AND IDENTITY
POLICY REQUEST
CONTACT AND DOCUMENT PREFERENCES
2.

Property, Occupancy, and Ownership

Complete this section for the residence to be insured.

PROPERTY ADDRESS AND OWNERSHIP
OCCUPANCY
USAGE AND BUSINESS ACTIVITY
Home-based business conducted on premises?
Any customers or employees visit the premises?
Any room, unit, or structure rented to others?
Any short-term rental activity (Airbnb/VRBO)?
PRIOR ADDRESS
3.

Dwelling Construction and Building Details

Use best available information; inspection reports may be attached.

CORE DWELLING CHARACTERISTICS
INTERIOR AND ATTACHED STRUCTURES
DETACHED STRUCTURES
SPECIAL CONSTRUCTION FEATURES
4.

Utilities, Systems, Protection, and Updates

Provide the year of the most recent complete update when known.

ELECTRICAL, PLUMBING, HEATING, AND COOLING
WATER AND FUEL SOURCES
FIRE AND SECURITY PROTECTION
SYSTEM CONDITION QUESTIONS
Any knob-and-tube, aluminum, or cloth wiring?
Any polybutylene, galvanized, or lead plumbing?
Any active leaks, unrepaired damage, or maintenance issues?
Any open permits or code violations?
5.

Premises Liability and Underwriting Exposures

Answer for the residence, yard, structures, and all household members.

ANIMALS
POOL, SPA, RECREATIONAL, AND PROPERTY FEATURES
HOUSEHOLD AND PREMISES EXPOSURES
Any firearms kept on premises?
Any wood stove, fireplace, or solid-fuel appliance?
Any unusually steep terrain, retaining wall, or cliff exposure?
Any prior foreclosure, bankruptcy, or insurance cancellation?
Any resident with a felony conviction or fraud-related offense?
VEHICLES AND STORAGE
6.

Coverage Selection and Valuation

Final limits are subject to replacement-cost estimation and carrier approval.

REQUESTED PROPERTY AND LIABILITY LIMITS
COVERAGE OPTIONS
SCHEDULED PROPERTY AND SPECIAL LIMITS
REPLACEMENT COST INFORMATION
7.

Loss History, Mortgagee, Remarks, and Authorization

Report all property and liability losses for all locations during the past five years.

LOSS HISTORY
Loss 1
Loss 2
Loss 3
Loss 4
MORTGAGEE / ADDITIONAL INTEREST
PRODUCER REMARKS AND ATTACHMENTS
APPLICANT AUTHORIZATION

I certify that the information in this application is true and complete to the best of my knowledge. I understand that material misrepresentation or omission may affect eligibility, coverage, or claims. I authorize the insurer and its representatives to obtain insurance scores, loss history, inspection data, and other underwriting information as permitted by law. This application does not bind coverage.

This application does not bind coverage. Your information is secure and never sold.