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Home > Homeowners > Homeowners
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Homeowners


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

First Name *
Last Name *
Phone
Street Address
City, State
ZIP / Postal Code *
Date of Birth *
/ /
Social Security Number
E-Mail Address *
Year Built
Calculate Functional Replacement Cost (only applies if Year built is before 1985)
Use Original Period/Restored Finishes
Total Finished Square Feet (including finished area in attic/additions)
Includes finished basement
Quality Grade




Addition 1:
Year Built
Square Feet
Stories
Addition 2:
Year Built
Square Feet
Stories
Use


Hold down the Ctrl Key to make multiple selections.
Style
Number of Stories








Foundation Shape:




Foundation Type: (Mark the foundation type for the living area only, not inlcuding the garage or carport.)
% Basement
% Shallow Basement
% Concrete Slab
% Crawlspace
% Deep Pilings
% Pier and Grade Beam
% Elevated Post/Pier and Beam (Stilts)
% Stilts with Sweep Away Walls
% Finished in Lowest Level
Roof Shape






Roof Type
Exterior Wall Construction and Finish
Floor Coverings
Kitchens
Bathrooms
Garage
Number of Cars
Living Space Above Garage %
Site Access



Foundation Material
% Brick
% Block
% Concrete
% Steel
% Stone
% Wood
% Other
Property Slope


Exterior
Exterior Doors
Exterior Windows
Exterior Trim and Details:
Number of Dormers
Interior
Average Wall Height
Wall Material (with %)
Wall Finish (with %)
Ceiling Finish (with %)
Heating System
Air Conditioning
Specialty Systems
Electrical Features
Fireplaces
Lighting
Staircases and Conveyances
Doors and Millwork
Other
Room Information
Bedrooms
Other
Additional Features
Pools and Spas
Handicap Accessible
Alternative Energy
User Defined Features
Attached Structures
Decks
Balconies
Porches
Breezeways
Patios
Other
Detatched Structures
Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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2005 W. Hamlin Rd. Suite 200
Rochester Hills, MI 48309
Ph: (586) 726-7800 | Fx: (248) 853-7063
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