Fred Meyer and Sons

*Step 2 of 4*
*Property Location:*
*Property Address:*
*Property Apt/Unit:*
*Property City*
*Property State*
*Tell us about the ins and outs of the place*
*Construction type*
*Foundation*
*Roof Type*
*Roof Age*
*Primary Heating System*
*Wiring Type*
*Bedrooms*
*Bathrooms*
*Garage Type*
*Number of stories*
*Approximate Square Footage*
*Security System*
*Fire Alarm*
*Municipal Location*
*Fire hydrant*
*Any Special Considerations?*
*Do you have any of the following breeds of dogs: Chow, Doberman, German Shepherd, Pit Bull, Rottweiler, Wolf Hybrid, or a mix of these?*	Yes No
*Is your home located in a flood plain?*	Yes No
*Select any additional property features that apply (optional):*	Dead Bolts Fire Extinguisher Trampoline Covered Desk/Patio Swimming Pool

*Step 3 of 4*
*What type of coverage do you need?*
*Replacement cost of dwelling (not including land)*	$
*Personal Liability Coverage*
*Desired Deductible*
*Have you reported any claims or losses to your insurance company within the past 5 years?*	Yes No
*Will this insurance replace an existing policy?*	Yes No
*Additional Coverage Options*
*Are you interested in Mortgage Protection coverage?*	Yes No
PLEASE READ: Mortgage protection insurance is a type of life insurance policy that helps to cover the outstanding balance on your home loan should a co-owner pass away. You will be contacted separately by Life Insurance agents for this type of coverage.