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

    Personal Insurance

    Business Insurance

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    Our Location

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

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