Replacement Cost Evaluation Form

If you are a current client, or purchasing a Home Insurance policy through us, complete this form to help us estimate the replacement cost on your home policy. Please fill out as much information as possible. Fields in bold are required

Name:
Address:
City:
State:
Zip:
Phone Number:
Best Time To Call:
E-mail Address:

Dwelling:

Total Living Area Sq. Footage
Year Built
Number of Stories
Foundation
Percentage Slab
Percentage Basement
Percentage Basement Finished
Walkout Basement	Yes No
Percentage Crawlspace
Exterior Siding
Roof
Have a garage?	Yes No
Attached or Detached?	Attached Detached
Number of Cars or Sq. Footage	Cars Sq. Ft.
List square footage and type for each porch, balcony or deck
Sliding Glass Doors
Skylights (small)
Skylights (large)
Atrium Windows
Picture Windows
Bay Windows
Bow Windows
Atrium Doors
Solar Panels
Other Specialty Items (list)
Interior Items:
Interior Walls
Wall Coverings	% % %
Ceilings
Flooring	% % % %
Kitchen
Number of Bathrooms	Full Half 3/4
Bathroom(s)
Fireplace
Wood Stove	Yes No
Spiral Staircase
Heating System
Air Conditioning	Yes No
French Doors	count each door as 1
Hot Tub	Yes No
Jacuzzi	Yes No
Wet Bar	Yes No
Interior Sprinkler System	Yes No
Central Burglar Alarm	Yes No
Central Vacuum	Yes No
Intercom System	Yes No
Central Fire Alarm	Yes No
Other Specialty Construction: i.e. Field Stove Fireplace, Solar Panels, Satellite, Built-In Book Cases, Corian Counter Tops, etc. Please list cost and item:
Comments:

Personal Auto Insurance

Home/Renters Insurance

Business Insurance

Download this FREE program from the Insurance Information Institute to easily develop a home inventory.

We‘ve compiled this checklist to help you identify areas where your insurance coverage can be improved.