ALOHA INSURANCE SERVICES

Homeowners / Dwelling Fire Insurance Quote
Policy Holder Information
Name(s) to appear on Policy
Mailing Address
City, State and Zip
Telephone Number
Fax Number
E-Mail Adddress
Property Information
Physical Address
City, State and Zip
Name of Condo Complex / Project
Tax Map Key Number (TMK)
If your property does not have a TMK Number, please provide the following: Year built, square footage of living area, square footage of garage or carport, square footage of any lanais or porches, description and square footage of any other structures attached to the house.
Amount of coverage needed to replace dwelling
Does property feature a swimming pool?	No Yes Is it fenced? Yes No Diving Board? Yes No
Hurricane Coverage?	Yes No If yes, select type Full Coverage Dwelling Only
Flood Coverage?	Yes No If yes, select type Full Coverage Dwelling Only
Earthquake Coverage?	Yes No If yes, select type Full Coverage Dwelling Only
Power supplied by electric company?	Yes No Other Description of Other
Water supplied by the County?	Yes No Other Description of Other
If catchment system, capacity in gallons
If Property is Over 25 Years Old
Name of contractor who performed the latest roof repair or replacement and date of work
Name of contractor who performed the latest electrical upgrade or repair and date of work
Name of contractor who performed the latest plumbing upgrade or repair and date of work
Date of last exterior painting

Occupancy Information
Who will occupy the property?	Owner Tenant Other
If owner occupied, is this your primary or secondary residence?	Primary Secondary
If this is your primary residence, would you like a home/auto package quote?	Yes No
If this is your secondary residence, is there a live-in or part time caretaker or property manage?	None Live-In Caretaker Part Time Caretaker Property Manager
Will a property manager be listed as an additional insured?	Yes No
Rental Property Information
Will you be renting any part of the property?	No Yes
If so, how many tenants?
Short term or long term rentals?	Long Term Short Term
Will the property be furnished?	Yes No
Amount of coverage desired for furnishings

Other Information
Are there any in-home business activities in the dwelling or farming on the property? If yes, please provide details.
Are there any pets or livestock on the property? If yes, please provide details.
Are there any items or structures requiring coverage that are not attached to the main dwelling? ( Swimming pool, detached garage, storage building, fencing, etc.)? If yes, please provide details and amount of coverage desired.
Any prior claims? If yes, please provide details.