Texas Insurance Service Center, Inc.| Insurance Services Harlingen, TX

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Name:*

Email Address:*

APPRAISAL REPORT

Insured:

Mailing Address:

Marital Status:

Home Phone:

Date of Birth:

SO. SEC. #:

Employment / Occupation:

ADDITIONAL(spouse)

Insured:

Date of Birth:

SO. SEC. #:

Employment / Occupation:

Occupancy:

Year of Construction / Type:

Maintenance:

Paint:

Condition of Roof/Type:

Surrounding Area:

Finish:

Custom Standard Economy

Heating System:

Central Space

Other:

Close Foundation:

Security:

Dead Bolt Locks Alarm System

Heat/Smoke Dept. Fire Extinguisher

Other:

Garage/Carport:

Other Improvements on Property

Remarks (losses Past 3 years):

Mortgagee Clause:

Premium Payor: Insured/Mortgagee
Present Value

Sq. Ft. of Living Area:

Sq. Ft. of Garage Area:

Total Sq. Feet:

Replacement Cost:

Actual Cash Value:

Property Address:

Please Enter and Copy Security Code Below.