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Home Replacement Cost
Home
Home Replacement Cost
Home Replacement Cost
Gravity Certs
2026-01-13T15:29:35-05:00
Date
MM slash DD slash YYYY
Referred by
Agent
Joe Rumer
Sue Rumer
Joe Rumer V
Scott Swieringa
Primary Insured
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Property Info
Type of property
(Required)
Primary home
Seasonal or secondary home
Rental home
Property settlement date (if new purchase) or your chosen effective date of new policy
Month
Day
Year
Current Insurance Company (Type NA if not current policy)
(Required)
Property Info
Year home was built
Square feet of living area
(do not include basement)
Purchase price of home
Month & Year home was purchased
Frame or masonry construction
Frame
Masonry
Is home a townhouse or condo?
Townhouse
Condo
Neither
Foundation (check all that apply)
Slab
Basement
Partial basement and slab
Walkout basement
Crawlspace
Is your basement finished?
25% or less finished
26% to 50% finished
21% to 76% finished
77% to 100% finished
Do you have a garage?
1 car garage
2 car garage
3 car garage
Carport
No garage
Is the garage attached or built in?
Attached (no living space above garage)
Built in (has living space above garage)
Do you have hardwood flooring?
(Required)
Yes 25%
Yes 50%
Yes 75%
Yes 100%
No hardwood floors
Do you have carpeted flooring?
(Required)
Yes 25%
Yes 50%
Yes 75%
Yes 100%
No hardwood floors
Do you have vinyl flooring?
(Required)
Yes 25%
Yes 50%
Yes 75%
Yes 100%
No hardwood floors
Do you have laminate flooring?
(Required)
Yes 25%
Yes 50%
Yes 75%
Yes 100%
No hardwood floors
Do you have tile flooring?
(Required)
Yes 25%
Yes 50%
Yes 75%
Yes 100%
No hardwood floors
What type of heat do you have?
(Required)
Gas Forced Air
Gas hot water
Oil hot air
Oil forced air
Electric/Heat pump
If oil heat, where is the tank located
In basement on masonry slab
Above ground - outside
Buried
In garage on slab
Do you have any vinyl siding?
Vinyl/Aluminum Under 25%
Vinyl/Aluminum 26-50%
Vinyl/Aluminum 51-75%
Vinyl/Aluminum 76-100%
Do you have any wood siding?
Wood less than 25%
Wood 26-50%
Wood 51-75%
Wood 76-100%
Do you have any solid brick/stone siding?
Solid Brick/Stone Less than 25%
Solid Brick/Stone 26-50%
Solid Brick/Stone 51-75%
Solid Brick/Stone 76-100%
Do you have any brick/stone veneer siding?
Brick/Stone veneer Less than 25%
Brick/Stone veneer 26-50%
Brick/Stone veneer 51-75%
Brick/Stone veneer 76-100%
What shape is your roof?
(Required)
Flat
Hip
Gable
What is your roof made out of?
(Required)
Asphalt shingles
Built-up Tar/Gravel
Rubber
Metal
Slate
Do you have any porches, patios, or decks? (check all that apply)
Open Porch
Wood Deck
Composite Deck
Screened Porch
Patio
Balcony
None
Describe your kitchen
Builders grade
Semi Custom (upgraded cabinets, solid counter top)
Custom (all the above plus granite countertops, ceiling height cabinets)
Designer (all the above and all specialty fixtures, cabinets, built in's etc)
What year was your roof last replaced?
(Required)
What year was your heating system replaced?
(Required)
When was any of your plumbing last updated?
(Required)
When was your electrical system last updated?
(Required)
Do you have a pool?
No pool
Above ground
Above ground with slide
Inground with slide or diving board
Inground with no slide or diving board
Do you have a trampoline
No trampoline
Trampoline with nets
Trampoline no nets
Any pets (give breed name)
Any alarms/sprinklers (check all that apply)
Interior sprinklers systems
Central burglar alarm
Central fire alarm
Fire extinguishers
Smoke detectors
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