Toll-Free 844-280-4686
Personal Information
Name Date of Birth
Address    
City State     ZIP
Home Phone Work Phone
E-Mail Address    
Current Homeowners Insurance Company    
Present Coverage Amount    
Renewal Date    
Occupation    
Claims in Last 3 Years    
Inside City Limits Yes    No Township
(if known)
Does anyone smoke in the household? Yes    No County
Dwelling Information
Square Footage - Living Space    
Year Home Built How many years at this address?
Type of Dwelling Distance from fire dept. (miles)
Building Design Distance from fire hydrant (feet)
Construction    
Foundation    
Roof Roof Age
Basement Finished Sq. Ft.
Fireplace Yes    No    
Wood Burner Yes    No    
Central Air Conditioning Yes    No    
Whirlpool Tub Yes    No    
Trampolines Yes    No    
Deck Sq. Ft.    
Porch Sq. Ft.    
Number of Dogs Breeds
Primary Mortgage Yes    No Who with?
 
Comments
 

Many people prefer to fax us a copy of their current policy deck sheets. Some send them as an e-mail attachment. If you wish, please do so. It
makes our quote more accurate. Be sure to send both sides. Our 24-hour fax is (248) 358-3308. We also have group discounts. If you belong to
an alumni group or you or your spouse is eligible to join one, let us know. Some other groups (often based on employment) offer discounts.
Ask us if your group is included.

Please click on the Submit button to send your estimate request. This is not an application for insurance, and it does not obligate
this agency to issue any policy of insurance.

 

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