Gordon Insurance - Home Owners Quote

Please complete to the best of your ability
and contact us for questions.

Legal Name of Homeowner:
Mailing Address:
City/State/Zip:
Is Mailing the same as Location address?	Yes No
What year was your house built?
Does it have?
Sprinklers	Yes No
Smoke Detectors	Yes No
Central Alarm	Yes No
Dead bolts	Yes No
If the House is more than 20 years old, what maintenance work has been done?
What is square footage of the house?
What is your current dwelling limit on the policy?
Are you concerned about Jewelry, Fine Arts, Silverware and Collectibles?	Yes No
Have you had any losses or claims in the past 3 years?	Yes No
If yes, please describe the date, claim and $'s paid
Which best describes the exterior of your house?	Siding Siding/Brick Brick
What is your deductible? ($250 is standard)	$250 $500 $1000
Explain special features on the property (ponds, pools, sheds, tree houses,etc)
Do you have any secondary homes?	Yes No
Miscellaneous comments:
Pease note Gordon Insurance can handle Auto, Umbrella and Workers Compensation needs. Do you wish to discuss them?	Yes No
Note;** All carriers subscribe to the CLUE System which will uncover claims/losses paid out over the history of the dwelling. So please tell the truth now as to avoid any embarrassment later.