Milton Wilson Additional Information Supplemental Information Step 1 of 4 25% Date of Birth* MM slash DD slash YYYY Industry*Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherOccupation* Phone Number*Email Address* Number of Fireplaces*"0" if there are noneExterior Walls*AdobeBrickBrick VeneerCement Fiber ShinglesClapboardExt Insul and Finish Sys (EIFS)LogsPoured ConcreteSiding, AluminumSiding, HardboardSiding, SteelSiding, VynilSiding, WoodSolid StoneStuccoFoundation TypeSlabCrawlspaceBasement - FinishedBasement - Partially FinishedBasement - UnfinishedDaylight Basement - FinishedDaylight Basement - Partially FinishedDaylight Basement - UnfinishedPiers/Pilings/StiltsRoof Covering Material*Architectural ShinglesAsphalt ShinglesCompositionCopperFiberglassRubberSlateTar & GravelTile (Clay)Tile (Spanish)Wood ShakeWood ShinglesOtherDo you have a Garage?* Yes No HiddenSection BreakType of Garage*Carport, AttachedCarport, DetachedGarage, AttachedGarage, DetachedGarage, BasementOtherUnknownGarage Size*1 Car (280 SF)1.5 Cars (396 SF)2 Cars (576 SF)2.5 Cars (672 SF)3 Cars (780 SF)3.5 Cars (884 SF) or moreHas your home been updated to totally eliminate a garage area by converting the area into living space?* Yes No HiddenSection BreakDo you have a swimming pool?* Yes No Is the pool protected by a self-latching fence that is at least four feet high?* Yes No Does your swimming pool have a diving board?* Yes No Is the pool filled with water?* Yes No Is there a trampoline in the yard?* Yes No Are there any firearms on the premises?* Yes No Number of Kitchens*1234Kitchen Grade*BasicBuilder's GradeSemi-CustomCustomDesignerNumber of Full Bathrooms*1234567 Are there residence employees?* Yes No Is there a business or daycare on the premises?* Yes No If yes, explain*Number of Employees*Do you have any domestic animals or pets?* Yes No Are there dogs on the premises? Yes No Does the home have exotic animals, farm or saddle animals?* Yes No HiddenSection BreakAre any of the dogs on the premises one of the following breeds: Akita, Chow, Doberman, Pitbull, Staffordshire Bull Terrier, Rottweiler, Presa Canarios, Wolf Hybrid, or mix of these?* Yes No Has any dog on the premises ever bitten to the point of breaking skin?* Yes No Type* Breed(s)* Bite History*"N/A" if no history Do you currently have homeowners or renters insurance?* Yes No Please select the reason for no prior coverage:*First Time HomeownerHas Been RentingPrior Ins Through Parent/Spouse/OtherCould Not Obtain Prior InsuranceDid Not Insure (Self-Insured)Please enter the Expiration Date of your current policy:* MM slash DD slash YYYY Prior Carrier* Number of Years with Prior Carrier*Number of Years with Continuous Coverage*Has your Home insurance ever been declined, cancelled or non-renewed?* Yes No Please provide details about the cancellation or declination above:*
