Homeowners Insurance Fact Finder Step 1 of 5 20% Date MM slash DD slash YYYY Referral Source(How did you hear about Williams Insurance Group?) Named InsuredName First Last Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How long have you lived at your current address? Number of Months PhoneMobile Home WorkEmail Marital StatusPlease selectSingleMarriedDivorcedWidowedOccupation DOB MM slash DD slash YYYY SSN Second Named Insured (If Applicable)RelationshipPlease selectFirst ChoiceSecond ChoiceThird ChoiceName First Last PhoneMobile Home WorkEmail Marital StatusPlease selectSingleMarriedDivorcedWidowedOccupation DOB MM slash DD slash YYYY SSN Property InformationProperty Location (if different from mailing address) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Is this a new purchase? Yes No What is the use of the property?Please selectFirst ChoiceSecond ChoiceThird ChoiceYear Built Total Square Feet Exterior Construction TypePlease selectFirst ChoiceSecond ChoiceThird ChoiceNumber of Bathrooms Is there a fireplace? Yes No What kind of fireplace? Gas Solid fuel Both Do you have a garage? Yes No What Kind of garage? Attached Detached Do you have a basement? Yes No Basement status is: Unfinished Partially finished Finished Approximate year of last update to the roof Approximate year of last update to the HVAC system Additional DetailsPets? Yes No Please list the type(s) and breed(s): Pool? Yes No Please check all that apply: Above Ground Inground Fenced Diving Board Slide Trampoline? Yes No Is it netted? Yes No Is an alarm system installed? Yes No What type of alarm? Who is your current insurance carrier? Any prior losses or claims in the last 5 years? Yes No Please provide an approximate date and description: Number of Household Residents Number of Household Occupants Under Age 21 Do any residents smoke? Yes No Comments: Δ