Home Owner Insurance Form

Quick Escrow Close for Home Owner Insurance

Please fill in the following form which will be submitted to the office of Arthur Keledjian and Jack Tahanian.

Buyer Name (1):

Buyer Name (2):

Date of birth (1):

Date of birth (2):

Social Security (1):

Social Security (2):

Phone number:

Property address:

City, State, ZIP

Mortgage/Lender:

Address:

City, State, ZIP

Loan Number:

Year built:

Square foot:

# of Units:

# of Stories:

# of Fireplaces:

# of Full Baths:

# of Half Baths:

# of Cars for Garage:

Attached?

Yes No

Central Air:

Yes No

Mort. Protection Ins:

Yes No

Sex:

Male Female

Nicotine:

Yes No

Escrow Officer:

Escrow Officer Tel:

Escrow Number:

Remarks: