
This summary page has been provided for you
so that you can quickly reference purchase cost and replacement cost for all
the rooms. You can print this form and store for your records.
| Room | Purchase Cost | Replacement Cost |
| Living Room | _____________________ | _____________________ |
| Entrance Hallways | _____________________ | _____________________ |
| Dinning Room | _____________________ | _____________________ |
| Family Room | _____________________ | _____________________ |
| Kitchen | _____________________ | _____________________ |
| Basement / Shed / Garage | _____________________ | _____________________ |
| Bathroom | _____________________ | _____________________ |
| Bathroom No.2 | _____________________ | _____________________ |
| Master Bedroom | _____________________ | _____________________ |
| Bedroom No.2 | _____________________ | _____________________ |
| Bedroom No.3 | _____________________ | _____________________ |
| Miscellaneous | _____________________ | _____________________ |
| TOTAL | _______________________ |