[Breathe – Agent Dwelling Quote Form]

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Agent Dwelling Quote Form

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EZLynxAppID
Required Information

This Quote From sends to PH Team.
Email
EZLynx App ID
Your Name*
The Client is
- New Client
- Existing Client
Client Information

Occupation
Phone
General Questions

Is this a New Purchase*
- No
- New Purchase
- Refinance
Type of Property*
- Primary Home
- Secondary Home
- Condo
- Townhome
- Rental Property
How many household members do you have?
How many household members are under age 18?
Purchase Date
MM slash DD slash YYYY
Closing Date
MM slash DD slash YYYY
Property same as the mailing address?*
- No
- Yes
Property Address
Street Address Address Line 2 City State ZIP Code
Property Information

Year Built
Bathroom Quality*
Full Bathrooms*
Three Quarter Bathrooms*
Half Bathrooms*
Kitchen Quality*
Basement Type*
Basement Walkout?
- Yes
- No
Basement Finished
Is there a sump pump?*
Is there a HOA or COOP?*
- NONE
- HOA
- Condo / Co-Op
Do you rent out this property?*
- No
- Short-Term (Airbnb, VRBO, etc)
- Long-Term (6+ month Lease)
Is the property located in a gated community?*
- No
- Yes
Is there a sprinkler system inside the property?*
- No
- Yes
Is there an actively monitored fire and/or burglar system?
- None
- Fire & Theft
- Fire Only
- Theft Only
Special Discounts possible for connected homes! Do you have any of the following?*
- None
- Smart Camera
- Smart Smoke Alarms
- Smart Lights
- Automatic Temperature Detector
- Water leakage/ automatic shut off
- Gas leakage detection/ automatic shut off
Is the property vacant or for sale?*
- No
- Yes
Does the Property have Solar Panels?*
Are Solar Panels owned or leased?
How many Solar Panels does the Property have?
Is there a trampoline?*
- No
- Yes
Does the Trampoline have a net aorund it?
Does this property have any of the following pool / hot tub features? (check all that apply)*
- NO Pool or Hot Tub
- Hot-Tub
- Pool
- Diving board
- Water Slide
Has the Roof been Updated?*
- Original
- Partial
- Complete
Roofing Material
Do you have any dogs?*
How many Dogs do you have?
Breed for Dog #1
Breed for Dog #2
Breed for Dog #3
Breed for Dog #4
Year Roof Updated
Hs the Furnace been Updated?*
- Original
- Partial
- Complete
Year Furnace Updated
Primary Heat Type
Is there a wood burning stove located in this property*
- Yes
- No
Has the A/C been updated?*
- Original
- Partial
- Complete
Year A/C Updated
Primary A/C Type
Has the Electrical been Updated?*
- Original
- Partial
- Complete
Year Electrical Updated
Electrical Updated
Has the Plumbing been Updated?*
- Original
- Partial
- Complete
Year Plumbing Updated
Plumbing Updated
Is there existing damage to the property?*
- No
- Yes
Provide details about existing damage
Do they have any claims in the past 5 years for this property?*
- No
- Yes
- Unknown
Provide details about the claim
Mortgage Information

Is this property owned by a Trust or LLC?*
- No
- Yes
Legal name of the Trust or LLC?
Is there a Mortgage on this property?*
- No
- Yes
Mortgage Company
Loan Number
Address
Street Address Address Line 2 City State ZIP Code
Do you have Notes to give PH Team?
Note to PH Team
Do you have documents to upload?

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Agent Dwelling Quote Form

Required Information

Client Information

General Questions

Property Information

Mortgage Information

Do you have documents to upload?