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Home Insurance Application

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Welcome to The Whitlock Group's Home Insurance Application

The information submitted will be used to quote your insurance with up to seven (7) companies. This form will take approximately 15 minutes to complete.
Complete the form as fully as possible as all questions are tied to rate surcharges and credits.

* indicates required

Before starting, have the following available for reference
- Current (or upcoming renewal) home insurance policy declaration page(s) and lender information (if applicable)
About You (the Insured) & Your Family
Primary Insured Name*
First Middle Last Suffix
Applicant's Physical Address*
Street Address Address Line 2 City State ZIP Code
County
Phone*
(###)###-####
Email*
Do You Own or Rent?*
- Own
- Rent
- Other
Have You Lived at this Address Longer than 3 Years?*
- Yes
- No
Prior Address
Street Address Address Line 2 City State ZIP Code
Do You Have an Alternate Mailing Address?*
- Yes
- No
Alternate Mailing Address
Street Address Address Line 2 City State ZIP Code
Date of Birth*
MM
DD
YYYY
Occupation*
Marital Status*
- Single
- Engaged
- Married
- Domestic Partnership
- Separated
- Divorced
- Widowed
Spouse/Fiancé/Partner's Name
First Middle Last Suffix
Their Date of Birth*
Month
Day
Year
Their Occupation
If Engaged, Will Your Partner Be Insured With You?
- Yes
- No
Does Your Former Partner Still Reside in the Household?
- Yes
- No
Effective Date of Policies*
MM
DD
YYYY
Upload Your Insurance Declaration Pages
Upload a current (or upcoming renewal) copy of Declaration Page(s) for each policy line of business to be quoted.
Drop files here or

Max. file size: 300 MB.

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About the Property
Is This Your Primary Residence?
- Yes
- No
Property Address to be Insured
Street Address Address Line 2 City State ZIP Code
County
If the address is not in Georgia, please select Other.
Residence Type*
- Single Family Dwelling
- Condo
- Apartment
- Mobile Home
- Co-op
- Townhouse
- Rowhouse (i.e. Duplex, Triplex, etc.)
- Other
Number of Units in Building
Is This a New Purchase?
- Yes
- No
Closing Date
MM
DD
YYYY
Sale/Contract Amount ($)
Expected Move-In Date
MM
DD
YYYY
Do You Have a Copy of the Appraisal?
- Yes
- No
Purchase Month/Year

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About the Construction
Construction / Siding Type*
If You Selected "Other" for the Siding Type, Please Fill In Your Siding Type.
Primary Foundation Type*
Select Your Basement Type
- Daylight
- Non-Daylight
What Percentage of Your Basement is Finished?
- Unfinished
- 25%
- 50%
- 75%
- 100%
Number of Stories*
Exclude Basements and Attics
Year Built*
Square Footage: Excluding Finished or Unfinished Basement, Garage, Attic Spaces, and Enclosed Porches*
Roof Shape*
Roof Material*
Garage Type*
Garage Size: Select the Vehicle Capacity*
Number of Full Baths*
Number of Half Baths*
Any Fireplaces?*
- Yes
- No
How Many Fireplaces Does Your Home Have?
What Kind of Fireplace(s) Does Your Home Have?
Check all that apply.
- Gas
- Electric
- Wood Burning
- Other
Any Freestanding Wood, Coal, or Pellet Burning Stoves in Your Home?*
- Yes
- No
Primary Source of Heat?*
List Most Approximate Year Any Updates Were Completed (YYYY)
Roof Heating Plumbing Electrical
Is Your Home Currently Insured?*
- Yes
- No
List Name of Current Property Insurance Carrier

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General Information Questions
Any Animals or Pets at the Residence?*
This Includes all indoor and outdoor animals/pets for all household members.
- Yes
- No
Any Dogs and/or Exotic Breeds?
- Yes
- No
List Type(s) and Breed(s).*
Any Bite History?
- Yes
- No
Own or Regularly Operate a Golf Cart?
- Yes
- No
Own or Regularly Operate an ATV?
- Yes
- No
Any Secondary Residences?*
- Yes
- No
Do You Conduct Any Type of Business on the Premises?*
- Yes
- No
Enter a Brief Description of the Business
Is Your Home (Or Any Part of It) Available for Rent?*
(i.e. room for rent, mother-in-law suite, basement apartment, home-sharing/swapping)
- Yes
- No
A Trampoline?*
- Yes
- No
Trampoline Features
Check all that apply.
- Safety Net
- Fence
- Locked Gate
- None
A Pool?*
- Yes
- No
Pool Type
- Above Ground
- In-Ground
Swimming Pool Features
Check all that apply.
- Diving Board and/or Slide
- Fence
- Locked Gate
- Automatic Safety Cover
- None
Is Your Water Heater Located in Your Attic?*
- Yes
- No
Is it a Tankless Water Heater?
- Yes
- No
Do You Have Trees and/or Branches That Overhang Your Roof Line?*
- Yes
- No
Select the Percentage of Overhang of the Roof Line.
- 0-10%
- 11-25%
- 26-50%
- 51-75%
- 76-100%
Is the Home Vacant or Unoccupied?*
- Yes
- No
Will it Be Occupied in the Next 30 Days?
- Yes
- No
Is the Home Under Construction or Renovation?
- Yes
- No
Is the Home Located in a Designated High Risk Flood Zone?*
- Yes
- No
- Unsure

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About Mortgagee & Others in Home
Does This Home Have a Mortgagee?*
- Yes
- No
Number of Mortgages
Lender Name (Optional)
Complete if not listed on declaration pages.
Address
Street Address Address Line 2 City State ZIP Code
Loan Number (Optional)
Is This Home Escrowed?
- Yes
- No
Select Any Below that Need to be Included on Your Policy.
- Additional Interests
- Additional Insureds
- Line of Equity
- Trusts
- Joint Owner
- Other
- None
Name (Optional)
Address
Street Address Address Line 2 City State ZIP Code
Interest Description
Give a brief description of any additional interest tied to the home (i.e. joint owner, estate executor, trustee, etc.).

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Credits, Discounts, & General Questions

DEFINITIONS
Local: The alarm is heard on your premises only.
Smart: A system notifies you through email, text message, or a mobile application. If the smart feature also notifies a third-party monitoring company, select "Central".
Central: A system that notifies a third-party monitoring company that contacts you, police, fire, or other emergency services.
NOTE: Discounts are possible and not 100%. This varies by carrier.
Burglar Alarm*
- Local
- Smart
- Central
- None
Fire Alarm*
- Local
- Central
- None
Smoke Detector*
- Battery
- Smart
- Local/Hardwired
- None
Select All that Apply to Your Residence.
- Deadbolts
- Fire Extinguisher
- Security Cameras (Interior)
- Security Cameras (Exterior)
- Key Card Entrance
- LEED Certified Home
- Solar Panels
- Automatic Water Shutoff
- Low Temp Sensor
Select All that Apply to Your Neighborhood.
- Gated Community
- Guard at Entrance
- Security Patrolling
- Homeowners Association (HOA)
- Condo Owners Association (COA)
- Property Owners Association (POA)
Any Property Claims or Losses in the Past 7 Years?*
- Yes
- No
- Not Applicable/First-Time Home Buyer
Provide the Date and Details of Each Claim/Loss.
Any Lapse in Coverage in the Last 5 Years?*
- Yes
- No
- Not Applicable/First-Time Home Buyer
How Many Years Have You Been with Your Current Insurance Company?

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Other Insurance
Would You Like Quotes on Any Additional Items? Check All that You Are Interested In.
An agent will be in touch to gather more information for lines outside of home and auto policies.
- Personal Umbrella/Excess Liability
- Builders Risk/Vacant Property/Vacant Home
- Classic/Collector Automobile
- Flood or Earthquake
- Inland Marine/Personal Floater (i.e. Jewelry, Art Work, Collectibles, etc.)
- Landlord/Dwelling Fire/Tenant/Short-Term Rental
- Motorcycle/Moped/Scooter/Dirtbike/ATV/Golf Cart
- Recreational Vehicle (RV)/Camper/Motorhome/5th Wheel
- Watercraft/Boat/Jetski/Yacht
- Auto
- Other
NOTE: Once your application is submitted, one of our Agents will contact you with quotes or to request additional information.
Remarks
Use this box to provide additional information, if needed.
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The Whitlock Group

2915 Premiere Parkway, Suite 120
Duluth, Georgia 30097

Main Office Number: 678-906- 2008
Office Fax: 855-906- 2012

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Client Portal

Insurance
- Commercial Insurance
- Personal Insurance
Analytics
Risk Management
Industry Specialties
Insurance Carriers
About Us
Blog

Insurance
- Commercial Insurance
- Personal Insurance
Analytics
Risk Management
Industry Specialties
Insurance Carriers
About Us
Blog

Home Insurance Application

Home Insurance Application

Step 1 of 7

Welcome to The Whitlock Group's Home Insurance Application

About You (the Insured) & Your Family

About the Property

About the Construction

General Information Questions

About Mortgagee & Others in Home

Credits, Discounts, & General Questions

Other Insurance