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document.write("*State \n");
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document.write("AK-Alaska \n");
document.write("AL-Alabama \n");
document.write("AR-Arkansas \n");
document.write("AZ-Arizona \n");
document.write("CA-California \n");
document.write("CO-Colorado \n");
document.write("CT-Connecticut \n");
document.write("DC-District of Columbia \n");
document.write("DE-Delaware \n");
document.write("FL-Florida \n");
document.write("GA-Georgia \n");
document.write("HI-Hawaii \n");
document.write("IA-Iowa \n");
document.write("ID-Idaho \n");
document.write("IL-Illinois \n");
document.write("IN-Indiana \n");
document.write("KS-Kansas \n");
document.write("KY-Kentucky \n");
document.write("LA-Louisiana \n");
document.write("MA-Massachusetts \n");
document.write("MD-Maryland \n");
document.write("ME-Maine \n");
document.write("MI-Michigan \n");
document.write("MN-Minnesota \n");
document.write("MO-Missouri \n");
document.write("MS-Mississippi \n");
document.write("MT-Montana \n");
document.write("NC-North Carolina \n");
document.write("ND-North Dakota \n");
document.write("NE-Nebraska \n");
document.write("NH-New Hampshire \n");
document.write("NJ-New Jersey \n");
document.write("NM-New Mexico \n");
document.write("NV-Nevada \n");
document.write("NY-New York \n");
document.write("OH-Ohio \n");
document.write("OK-Oklahoma \n");
document.write("OR-Oregon \n");
document.write("OT-Other \n");
document.write("PA-Pennsylvania \n");
document.write("RI-Rhode Island \n");
document.write("SC-South Carolina \n");
document.write("SD-South Dakota \n");
document.write("TN-Tennessee \n");
document.write("TX-Texas \n");
document.write("UT-Utah \n");
document.write("VA-Virginia \n");
document.write("VT-Vermont \n");
document.write("WA-Washington \n");
document.write("WI-Wisconsin \n");
document.write("WV-West Virginia \n");
document.write("WY-Wyoming \n");
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document.write("Home Phone: \n");
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Spouse \n");
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document.write("
Children (in household only) Homeowner Insurance Review Questionnaire
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document.write("To assist us in protecting you against possible uninsured losses,
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document.write(" Do you wish to make any changes \n");
document.write(" Have you made any improvements or renovations If your home is over 29 years old, have you upgraded any of the following: If yes, please describe below. For example: new roof - 2002; new central air - 1999.)
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document.write("Home improvements (item - year installed) \n");
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document.write(" Is the name on the policy the same \n");
document.write(" Is the mortgage information shown on the policy correct? \n");
document.write(" Is your premium paid from your escrow account? Do you own any of the following that exceeds $1,000 in value: \n");
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document.write("Valuables (Item - Value) \n");
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\n");
document.write(" Do you work, maintain or operate a business, \n");
document.write(" Do you own any water craft? \n");
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document.write("If yes, please describe (Power/sail, HP, length) \n");
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document.write(" Do you have a swimming pool? \n");
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document.write("If yes, describe (value of pool, is there a diving board \n");
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document.write("Home Descr"+"iption - # of stories, Sliding Glass doors \n");
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document.write("Roof Type: Shingle, Barrel Tile, or Concrete Tile. \n");
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Square footage of home under air conditioning \n");
document.write(" Do you own any animals? \n");
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document.write("If yes, describe (type of animal, if dog, dominent breed, \n");
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Automobile Insurance Review Questionnaire
\n");
document.write("To assist us in protecting you against possible uninsured losses,
\n");
document.write(" Do you wish to make any changes in the coverages on your \n");
document.write(" Do you have a vehicle, not owned by you, \n");
document.write(" If your vehicle is a pickup truck, does it have a cap, or \n");
document.write(" Are there any non-household members who regularly \n");
document.write(" If your vehicle is financed, is the leinholder \n");
document.write(" Is your vehicle leased? \n");
document.write(" Do you have a car phone, stereo, or other electronic device \n");
document.write(" Is your vehicle used in your business? \n");
document.write(" Do you drive your vehicle to and from work? \n");
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document.write("Please list all licensed drivers in your household \n");
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\n");
document.write(" Would you be interested in a quote for life, disability,
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