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SANDY PINES INSURANCE QUOTE INFORMATION
CURRENT INSURANCE INFORMATION
Company:
Expiration Date:
Policy Number:
POLICY HOLDER INFORMATION
Name:
DOB:
Home Phone:
Spouses Name:
Work Phone:
Address:
Cell Phone:
Email:
Property Address:
Year Built:
Within 5 Miles of Fire Dept?
Yes No
Fire Dept Servicing?
Within 1000 Ft. of a Hydrant?
Model (Name):
Serial #
Length:
Width:
Do you have a screened enclosure? Yes No
If yes, What size?
UNDERWRITING QUESTIONS
Smoker:
Do you have a woodstove?
If, yes, UL approved?
Dogs?
Breed
Fenced in yard?
Hot Tub?
Locking Cover? Yes No
Trampoline?
Type
Year
Make
Model
Serial#/Vin#
CC
Value
Hull ID#
I/B or O/B
Horsepower
Length
N/A Inboard Outboard
DESCRIBE ALL CLAIMS IN THE PAST THREE YEARS:
HOME FEATURES COVERAGES
Amount to Insure For: (Does this include screen enclosure?)
Deductible:
Type of Policy::
