HOMEOWNERS QUOTE

PLEASE NOTE: THIS QUOTE IS AVAILABLE IN MICHIGAN

Attention: This form contains drop-down menus to save you time. Note that some fields contain default answers. If you do not change this information by selecting a different item from the drop-down list, we will assume the default is accurate for you, and quote accordingly. For the fields labeled Select, please choose one of the items in the drop-down list.
TODAY'S DATE:

APPLICANT

NAME:
MAILING ADDRESS:
CITY/STATE/ZIP:
E-MAIL:
HOME PHONE:
BUSINESS PHONE:
FAX:
HOW WOULD YOU PREFER TO BE CONTACTED:  

CURRENT HOMEOWNERS INSURANCE COMPANY

ARE YOU A NEW HOMEOWNER?   

RESIDENCE TO BE INSURED

STREET ADDRESS:  
CITY/STATE/ZIP:  
RESPONDING FIRE DEPARTMENT:  
 
MILES FROM
FIRE
DEPARTMENT		 FIRE HYDRANT
WITHIN
1,000 FEET?
 

ABOUT YOUR RESIDENCE

                            IF OTHER, PLEASE DESCRIBE
TYPE:
MARKET
VALUE:		 REPLACEMENT 
COST:		  
           IF BRICK, NOTE % YR OF CONST.
SQUARE
FEET:		 CONSTRUCTION:
  ENTER YEAR   ENTER YEAR  
AGE OF
ROOF:		 AGE OF 
FURNACE:		  
ENTER YEAR OF LATEST UPDATES, IF KNOWN, AND DESCRIBE CONDITION
AGE OF
PLUMBING:
ENTER YEAR OF LATEST UPDATES, IF KNOWN, AND DESCRIBE CONDITION
AGE OF
WIRING:
DO YOU HAVE A SWIMMING POOL?
DO YOU HAVE A TRAMPOLINE?
IF YOU ANSWERED YES TO EITHER OF THESE QUESTIONS, IS YOUR YARD SECURELY FENCED?

SAFETY

PLEASE PROVIDE THE FOLLOWING INFORMATION AND/OR CHECK THE BOXES FOR YES.

DO YOU HAVE SMOKE DETECTORS? HOW MANY?   
DO YOU HAVE AT LEAST ONE FIRE EXTINGUISHER?
DO YOU HAVE A WOODBURNER? NOTE: A FIREPLACE IS NOT A WOODBURNER.
DO YOU HAVE DEADBOLT LOCKS ON ALL DOORS LEADING OUTSIDE?
DO YOU HAVE AN ALARM SYSTEM? IF YES, DESCRIBE HOW IT WORKS.

YOU AND YOUR FAMILY

PLEASE PROVIDE THE FOLLOWING INFORMATION AND/OR CHECK THE BOXES FOR YES.

DOES ANYONE IN THE HOUSEHOLD SMOKE?
DO YOU HAVE BORDERS OR TENANTS? IF YES, PLEASE ELABORATE.
HAVE YOU BEEN CANCELED OR NON-RENEWED BY AN INSURANCE COMPANY? IF YES, PLEASE EXPLAIN.
HAVE YOU PLACED A CLAIM WITH ANY INSURANCE COMPANY IN THE PAST 5 YEARS? IF YES, PLEASE EXPLAIN AND PROVIDE NAME OF COMPANY.
DO YOU HAVE PETS? PLEASE LIST THEM. IF YOU HAVE DOGS, NOTE THEIR BREEDS.
ARE YOU A MEMBER OF A COLLEGE ALUMNI ASSOCIATION; MEA; AARP; MICHIGAN ASSOCIATION OF COMMUNITY BANKERS; OR OTHER GROUP? IF SO, PLEASE NOTE.

COVERAGE AND DEDUCTIONS

HOW MUCH COVERAGE DO YOU WANT ON YOUR DWELLING?
SELECT DESIRED DEDUCTIBLE.
SELECT DESIRED LIABILITY LIMIT.
SELECT DESIRED GUEST MEDICAL PAYMENT LIMIT.


FYI:
  
Some companies offer substantial savings on both your Auto and Homeowners Insurance rates when they write both. Check here if you are interested in a combined quote, and fill out our Auto Quote form.

After you click the Submit button below, you will be redirected to our Quotes page, where you can select the Auto Quote form if desired. Thank you for your interest. We will respond promptly.