Mark Reid Insurance

Requestor Information

First Name:*

Last Name:*

Email Address:*

Phone Number:*

Home Location

Street Address:*

City:*

County:*

State:

Zip Code:*

Roof

Roof material:*

Age of Roof:*

Warranty of surface material, in years:*

Condition of Roof:*

Additional Comments:

Plumbing

Pipes made of:*

How old is the plumbing or in what year was it last updated?*

Was the work performed by a licensed plumbing contractor?

Yes No

Please describe the extent of the work completed:

Additional Comments:

Electrical

Amperage Rating:*

How old is the electrical system or in what year was it last updated?*

Was the work performed by a licensed electrical contractor?

Yes No

Please describe the extent of the work completed:

Other Comments:

Heating and Cooling System

Type of Heating/Cooling System:*

If applicable, please indicate oil tank location.

How old is the heating system or in what year was it last updated?*

Is it serviced annually?*

Yes No

Date last serviced:*

Is there a secondary or supplemental heat source?*

Yes No

If yes, was it professionally installed?

Yes No

Is it cleanded or serviced annually?

Yes No

Type of Hot Water Heater:*

When was it installed?*

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Home Update Questionnaire