Insurance products are: Not a deposit, not FDIC Insured, Not Insured by any federal government agency, Not guaranteed by the Bank and may go down in value.
The some of the following questions may require information contained on your current homeowners policy. If you do not have your current policy available for review leave the "answer" provided. You may leave comments or questions at the end of the questionaire.
HO Form Select Home Owner Tenant/Renter Condominium Owner Inside City Limits? Yes No Is This a Primary or Secondary Residence? Select Primary Secondary Year Built Construction Type Select Frame Stucco Brick Deductible Amount Select 100 250 500 1000 2500 Value of Residence:
Personal Liability Select 100,000 200,000 300,000 400,000 500,000 1,000,000 Medical Payment Select 1000 2000 3000 4000 5000 10000
Replacement Cost on Dwelling Replacement Cost on Contents
Smoke Detectors Dead Bolt Locks Fire Extinguisher Non Smoker Central Station Burglar Alarm Central Station Fire Alarm Police Station Direct Alarm Fire Station Direct Alarm Local Burlar Alarm Local Fire Alarm Automatic Sprinkler - All Areas Automatic Sprinkler - Excluding Attic, Bath, Closet
Scheduled Property - Enter Total Dollar Amount of Itemized Coverage for each Category
Silverware: Camera: Musical Instr.: Personal Furs: Personal Jewelry: Jewelry in Vaults: Guns: Golf Equipment:
Earthquake Coverage? (Not Covered unless you select coverage) Select No Yes Flood Coverage? (Not Covered unless you select coverage) Select No Yes Please list all claims and amounts paid for the last 3 years: Use this area for any special comments or coverages which need special attention. Do you currently have homeowners insurance? Yes No Who is you current homeowners insurance company? When does your current policy expire?
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