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Homeowners Insurance Fact Finder

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Date

MM slash DD slash YYYY

Referral Source

(How did you hear about Williams Insurance Group?)

Named Insured

Name

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

Phone

Mobile Home Work

Email

Marital Status

Occupation

DOB

MM slash DD slash YYYY

SSN

Second Named Insured (If Applicable)

Relationship

Name

First Last

Phone

Mobile Home Work

Email

Marital Status

Occupation

DOB

MM slash DD slash YYYY

SSN

Property Information

Property 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?

Year Built

Total Square Feet

Exterior Construction Type

Number 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 Details

Pets?

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:

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Williams Insurance Group

256 Seaboard Lane, Suite H-102
Franklin, Tennessee 37067

(615) 850 4222
hello@williamsgrouptn.com

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The Quick Guide to Understanding Your Policy, Making Informed Decisions, and Getting the Best Coverage

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