EIGI – Employers Insurance Group, Inc.

Request A Quote – Homeowners

Name:

Address:

City:

State:

Zip Code:

Day Time Phone:

Cell Phone:

Email:

Preferred Contact Method:

Dwelling Information

1. What year was your home built?

Type of home?

2. What style is your home?

1 Story	1.5 Story
2 Story	2.5 Story
Bi-Level	Split Level
Other

3. What is the total square footage of the finished
living area of your home?

4. Does your home have a:

Deck Sq. Ft.

Cathedral Ceilings % of home

Breezeway Sq. Ft. Is Breezeway:

Porch Sq. Ft. Is Porch:

5. Which of the following additional features
are in your home?

Skylights #	Picture Window #
Bay Windows #	Glass Sliding Door #
Bow Windows #	Atrium Window #
Atrium/French Door #	Central Alarm %
Woodstove #	Hot Tub Sq.Ft.
Wet Bar #	Greenhouse Sq.Ft.

6. Do you have a Garage?

Yes No

Type:

How many vehicles can be parked in the garage?

7. Does your home have a basement?

Yes No

If yes, percentage finished %

8. If your home does not have a full basement,
what percentage is:

Slab %

Crawl Space %

Stilts %

9. Which materials listed below best describe the
materials found in your home? Please indicate the
materials as percentages of total
(e.g. 5%, 10%, 15%, etc.)

EXTERIOR WALLS:

Clapboard %	Wood Siding %
Aluminum Siding %	Vinyl Siding %
Wood Shakes %	Brick Veneer %
Stone Veneer %	Stucco %
Block %	Solid Brick %
Solid Stone %	Masonry %
Log %	T-111 %

INTERIOR WALLS:

Plaster %	Dry Wall %
Studs Only %

WALL FINISHES:

Paint %	Faux Finish %
Wallpaper %	Paneling %
Ceramic Tile %	Brick %
Stone %	Marble %
Knotty Pine %

ROOF COVER:

Asphalt %	Metal %
Slate %	Clay Tile %
Wood Shakes %	Tar & Gravel %
Rubber %

CEILINGS:

Drywall %	Plaster %
Acoustic Tile %	Wood %
Other %

FLOOR COVERINGS:

Hardwood %	W to W Carpet %
W to W over Hardwood %	Wool/Berber Carpet %
Parquet %	Ceramic Tile %
Marble Tile %	Slate %
Brick %

10. How many kitchens are in your home?

Please indicate if any of your kitchens have
the following features:

Corian, Granite, or Authentic Marble Countertop	Center Island with Cabinets or Sink
Jenn-Aire Stove	Walk-in Freezer
Sub-Zero Refrigerator	Motorized Pantry
Indoor BBQ

11. Please indicate the number of bathrooms that are:

Full (3 or more fixtures w/ tub)

Half (sink, toilet, stand-up shower)

Half (sink/toilet only)

Please indicate quality:

12. What is your homes primary source of heat?

Oil Gas Electric

Other

If you heat with oil, where is the storage tank located:

Basement	Outside-Above Ground
Garage	Outside-Under Ground
Other

Do you have a secondary source of heat?

Yes No

If yes, please describe:

13. Does your home have central air conditioning?

Yes No

If yes, does it share ducts with the heating system?

Yes No

14. Does your home have a central vacuum system?

Yes No

15. How many fireplaces with masonry chimneys?

None	Single #
Double #	Triple #

(DOUBLE is two fireboxes and one chimney,
TRIPLE is three fireboxes and one chimney)

16. Losses?
Yes No

dates:

How much paid out?

17. Detached Structures?

Yes No

If yes, what type of structure?

18. Animals or Exotic Pets?

Yes No

If yes, what type?

19. Trampoline?

Yes No

20. Pool?

Yes No

If yes, is it? Inground Above

Fenced? Yes No