HOME QUOTE

ATTENTION: THIS QUOTE IS ONLY AVAILABLE IN MICHIGAN.
For the fields labeled Select, please choose one of the items in the drop-down list.


 
Today’s date (MM/DD/YY):
 

 

APPLICANT

Name:
Mailing Address:
City/State/Zip:
E-mail:
Cell Phone:
Home Phone:
Business Phone:
Fax:
 
How would you prefer to be contacted:
 

 
Current Home Insurance Carrier:
Are you a new homeowner? :
 

 

RESIDENCE TO BE INSURED

Address:
City/State/Zip:
Responding Fire Department:
Miles from Fire Department:
Is there a fire hydrant within 1,000 feet? :
 

 

ABOUT YOUR RESIDENCE

Type:
If Other please describe:
Market Value:
Replacement Cost:
Construction:
If Brick give %:
Year of Construction:
Age of Roof:
Age of furnace:
Age of plumbing:
Please explain the condition of plumbing:
Age of wiring:
Please explain the condition of wiring:
Is there a swimming pool? :
Is there a trampoline? :
Is your yard securely fenced? :
 

 

SAFETY

How many smoke detectors in your residence?:
Do you have a fire extinguisher? :
Do you have a woodburner (this does not include fireplace)? :
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

Does anyone in your family smoke? :
Do you have boarders and/or tenants? :
If yes please explain?:
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 elaborate, include how much money was paid on the claim:
Do you have any pets? :
If yes please list them and if you have dogs list their breeds?:
Are you a member of an Alumni Association, MEA, AARP, Michigan Association of Community Bankers, etc…? :
If yes please list them?:

 

COVERAGE AND DEDUCTIONS

How much coverage do you want on your home?:
Select a desired deductible :
Select a desired liability limit :
Select a desired guest medical payment limit :
 

 
  Check here if you are interested in a combined quote.*
* Some companies offer substantial savings on both your Auto and Homeowners Insurance rates when they write both.
 
After you click the Submit button below, you will be redirected to our Quotes page, where you can select the Homeowners Quote form if desired. Thank you for your interest. We will respond promptly.