Homeowner’s Questionnaire
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Arthur Hall Insurance | 101 East Chestnut St. | Post Office Box 512 | West Chester, PA 19381 
610-696-2394 | Fax: 610-436-9675

To speak to a customer service representative,
call our office at 610-696-2394 during normal business hours.

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To request a quote using our secure server, please fill in the following information.
Required information*

*Date:
 
*Applicant First Name:
 
*Applicant Last Name:
 
*Applicant SS #:     000-00-0000
*Applicant DOB:    mm/dd/yyyy
Co-Applicant First Name:
 
Co-Applicant Last Name:
 
Co-Applicant SS #:     000-00-0000
Co-Applicant DOB:   mm/dd/yyyy
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Mailing (Current) Address
    
*Street Address:
 
*City:
  
*Township/Borough:  
*State:
   *Zip:
*How long at
current address?		  

Previous Address:
(less than 5 years at current address)

  
Home Phone:
 
Work Phone:
 
Cell Phone:  
*Email Address:
 

Employer:

  
Property (Risk) Address
    
*Purchase Date (month/year):   mm/yyyy
  Property is the same as the mailing address above
*Street Address:
 
*City:
  
*Township/Borough:  
*State:
   *Zip:
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Current Insurance Information
Company Name:  
Expiration Date:   mm/dd/yyyy
Coverage Amount:  
Liability Amount:  
Market Value:  
Mortgage:  
Do You Have Losses?   No   Yes, explain
If New Purchase,
Mortgage Amount:		     Settlement Date: 
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Construction Information
    
Year Built:  
Number of Stories:  
Square Footage:  
Type:  
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Style:   Colonial  Ranch  Split Level  Cape Cod  Contemporary 
Row House:  End  or  Center  
Town House:  End  or  Center  
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Siding:   Vinyl  Stucco  Brick  Stone  Asbestos 
Wood   Aluminum  
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Age of Roof:  
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Type of Roof:   Asphalt   Slate   Cedar   Asbestos 
Other  
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Do You Have a Garage?   No   Yes, Number of Cars:
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Type of Garage:   Attached  Detached  Built-In  Basement   
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Do You Have a Deck?   No   Yes, Square Footage:
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Do You Have a Porch?   No   Yes, Square Footage:
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Do You Have a Pool?   No   Yes
If Yes, Check All That Apply: Fenced  Locked Gate
Diving Board   Slide
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Do You Have
Any of the Following?		   Trampoline  Skateboard Ramp   Hot Tub 
Other, explain  
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Do You Have a Basement?   Yes  No  
If Yes, Check All That Apply: Full Basement, finished %
Sump Pump  French Drains  
If No, Type of Foundation: Slab  Crawl Space  
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Heat:   Age:
Type: Electric  Gas   Heat Pump   Oil, Location  
Central Air  
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Wiring:   Age:
Type: Circuit Breakers   Fuses   Knob & Tube   Aluminum
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Plumbing:   Age:
Type: Copper   PVC   Lead  
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Number of Baths:   Full:   Powder:
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Number of Fireplaces:   Wood:   Gas:
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Do You Have a Woodstove?   No   Yes, Was it Professionally Installed?  Yes  No  
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Fire Protection:   Name: Number of Miles Away:
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Safety Features:   Smoke Detectors  Fire Extinguisher  Sprinklers  Dead Bolts 
Central Fire  Central Burglar  
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Do You Have a
Business in Your Home?		   No   Yes, Type of Business:  
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Do You Have
Any Scheduled Items?		   No   Yes, List Items and Value:  
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Do You Have
Any Pets?		   No   Yes, Type & Breed:  
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Do You Belong to a Homeowner's Association?   No   Yes  
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Comments:

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Please click here to contact an Arthur Hall professional,
or call us now at 610-696-2394. We will be glad to help you
with any questions you may have.

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Arthur Hall Insurance
Pennsylvania Office | 101 East Chestnut St., P.O. Box 512, West Chester, PA 19381-0512
610-696-2394 | Fax: 610-436-9675
Delaware Office | 4 West Rockland Rd., P.O. Box 70, Montchanin, DE 19710
302-658-0100 | Fax 302-658-2575
Voted the #1 Insurance Agency in Chester County (1993 - 2008)

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