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High Value Home Quote
High Value Home Quote
Mike Schmisek
2021-02-22T16:57:58-07:00
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Address
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Date of Birth
*
Year Roof was last replaced:
Roof Type:
Year Cooling was last replaced:
Year Heating was last replaced:
Year Wiring was last replaced (if ever):
Year Plumbing was last replaced (if ever):
Number of occupants living in the house:
Current Insurance Carrier:
Protective Devices (Check all that apply to your home)
Local Burglar Alarm (Audible)
Central Station Burglar Alarm
Central Station Fire Alarm
Fire Sprinkler System
Automatic Water Shut Off Valve
Closed Circuit Cameras Monitored 24 hours a day
24 Hour Security
Doormen who verify/announce visitors
Temperature Monitoring System
Water Leakage Detection System
Gas Leakage Detection System
Whole House Back-Up Generator
Located in a Gated Community
Request
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Has any household member been convicted of a felony?
Yes
No
Are there any business activities including day care or farming operations conducted on premises?
Yes
No
Does anyone in the household own any pets that would be considered exotic or unusual?
Yes
No
Does anyone in the household own any of the following breeds or mixes of these breeds? (Pit Bull, Rottweiler, Chow-Chow, Doberman Pinscher, Presa Canario, Wolf Hybrid)
Yes
No
Are there any animals with a bite history?
Yes
No
Is this house under construction or undergoing major renovations?
Yes
No
Is there/will there be a mortgage?
Yes
No
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