Jordan Ewart Insurance - House Work Sheet

Homeowners Guarantee Worksheet

Contact Information
Name:
Address:
City:
Postal Code:
Phone #:
Work #:
Fax #:
E-mail:
Date of Birth:
Insurance History
Claims:
Type of Claims:
Approximate Payout:
Previous Insurance:
Policy #:
Expiry:
Is there a mortgage?
If so to what bank?
How long have you had house insurance?

General Information

Type of Home

Bungalow

1 1/2 Storey

2 Storey

Split Level

Bi Level

Duplex

Townhouse

Type of Siding:

(Stucco, Wood, Aluminum, Vinyl, Brick Veneer, Artificial Stone, Solid Brick, Native Stone)

Ground Floor Area (sq. ft.):

Percentage of Siding:

Basement Area (sq. ft.):

Year Built:

Completed Area (sq. ft.):

Additional Features
Bathrooms	Fireplace
Extra #:	Chimney:
Full Baths (3 fixtures):	Number of Hearths:
Half Baths (2 fixtures):	Gas:
Garage	Updates
Type:	Roof:	yr
Size:	Plumbing:	yr
Heated:	Electrical:	yr
	Heating:	yr
Shingles	Swimming Pool
Type:	Is there a swimming pool?
Approximate year of installation:	Type:	Inground Above ground
	Construction:	Cement Vinyl
	Size:
	Sauna, Hot Tub, Jacuzzi:
Other Features	Other Items
Central Air Conditioning:	Boat:
Central Vacuum System:	Value of Boat:
Centrally Monitored Alarm:	Motor:
Neighborhood Watch:	Value of Motor:
Size of Wood or Cement Deck:	HorsePower?
Roof Over Deck?:	Motor Type:	Inboard Outboard
Size of roof over deck:	Jewellry:

How likely are you to use our drive through for Plate and License renewal?

Would an online insurance quote program benefit you?

During which time of day will you do most of your insurance business?

2007-07-25

Jordan Ewart Insurance is open 6 days a week

Monday to Thursday
8:00 am to 8:00 pm

Friday
8:00 am to 6:00 pm
Saturday
9:00 am – 5:00 pm.