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First Name
Last Name
TAX ID*
Building Value*
Replacement Cost? YESNO
Content Value
Age of Building*
Number of Stories*
Exterior Construction Type*
Roof Type*
Sprinkler System?* YESNO
Building Square Footage*
Address of Property*
City
State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
ZIP Code
Inside City Limits?* YESNO
Owner Occupied?* YESNO
Multiple Locations? YESNO
Type of Business*
Gross Sales
Payroll
Liability Limits* $100,000$300,000$500,000$1,000,000$2,000,000$2,000,000 and higher
