Home Update Questionaire

Location and Hours

Address: 17 Front St. Weymouth, MA 02188
Phone: (781)-337-0427
Fax (781)-335-6897
Email: agent@cgjordan.com
Hours: 9:00 am – 5:00 pm

Home Update Questionaire Form

Requester Information

Full Name

Phone

Fax

Email

Preferred Contac Method

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 Roof Comments

Plumbing

Pipes Material

Age of Plumbing

Was the work performed by a licensed plumbing contractor?

Please describe the extent of the plumbing work completed:

Additional Plumbing Comments

Electrical

Amperage Rating

Age of Electrical System

Was the work performed by a licensed electric contractor?

Please describe the extent of the electrical work completed:

Additional Electrical Comments

Heating and Cooling System

Type of Heating/Cooling System

Please indicate oil tank location

Age of heating system

Is it serviced annually

Date last serviced

Is there a secondary or supplemental heat source?

If yes, was it professionally installed?

Is it cleanded or serviced annually?

Type of Water Heater

When was it installed?

Other Heating and Cooling Comments or Questions::

Binding Agreement

This submission is a request. Insurance coverage changes and new coverage are not effective until we confirm that for you.
We will do our best to complete this request based on the information you provide. The more complete your information, the more accurate your quote will be.
I understand that any policy changes and quote requests are effective only when I have received a written confirmation


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Address: 17 Front St. Weymouth, MA 02188
Phone: (781)-337-0427
Email: agent@cgjordan.com

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