Georgia Vacant Home quote

Vacant Home quote

Jack Bradley Agency

Vacant Home Quote

Name ✶

Phone ✶

Email ✶

Mailing Address ✶

Physical Address

How did you hear about our agency?

Web Address

Insured Name

Insured DOB

Insured SSN

Spouse Name

Spouse DOB

Spouse SSN

Is the deed to the home in a Trust or LLC?

Fire Station Name

Miles to station

Hydrant Distance

Inside City Limits?

PC

Home Information

Year Built

Purchase Date

Number of Full Baths

Number of Stories

Total Sq Footage

Number of Half Baths

Construction

Siding

Central Heat/Air (Gas, Electric)

Porch Sq Footage

Fireplace (Gas, Wood)

Woodstove/Other

Deck Sq Footage

Roof Material

Roof Year

Foundation (Crawl Space, Basement, Slab)

Finished/Unfinished

Garage (Carport, Attached, Not Attached)

Homes Older Than 20 Years

Heating (Year Updated)

Wiring (Year Updated/Circuit Breakers)

Roof (Year Updated)

Credits

Dead Bolt

Smoke Detector

Fire Extinguisher

Security System

Additional Information

Current Company

Expiration Date

Prior Cancelled? (Reason)

Prior Losses? (Description)

Swimming Pool (enclosed)

Other Hazards

Is this a new purchase?

Additional Info

How long vacant?

Reason for Vacancy

Renovation Notes

L&I Contractor?

Amount of Coverage

Building

Other Structures

Contents

V&MM

Deductible

Policy Term

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