Homeowners Insurance in Lynchburg, VA

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*Name

*Date of Birth

*Property address to be insured

Is this a new purchase, or your current residence?

*If you have lived at this address less than 5 years, please provide your prior address.

*Is this home deeded in the name of an LLC or Trust?

*What company is your current homeowners insurance with and how long?

*Have you had a homeowners insurance policy be nonrenewed or cancelled by the company in the past 5 year? If so, please provide details.

*Is the home a mobile home, modular home or stick built?

*Year Built:

*Age of roof:

*Type of Heat and age:

*Electrical Amp service and year of last update?

*Any knob and tube wiring or fuses in the home?

*Plumbing type?

*Dog(s)? If so what breed(s) and do they have a bite history?

*Farm animals or exotic pets?

*Pool? (Inground, Above Ground, Locking fence, Diving Board, Slide)

If yes, is it Inground, Above Ground or Temporary?

Is there a fence (4ft or higher) with a working lock?

Is there a Diving Board, Jump Board, and/or Slide?

*Trampoline? (Netted and anchored?)

*Woodstove?

*Fireplace? (Garages, Sheds, Barns, Treehouses, Swing Sets, Jungle Gyms, Slides, Zip lines, Climbing walls, etc)

Does the home have Solar Panels?

How many panels are installed?

Is there a backup battery storage system?

Are the panels owned, leased, or financed?

Does the property have an electric vehicle (EV) charging station? If yes, please specify its location (e.g., garage, driveway, exterior wall)

*Are any businesses operated out of the home including short term rentals? If yes, please provide details and General Liability Company

*How many residents?

*Any bankruptcy or judgements in the last 7 years?

*Phone number

*Email

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