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Our Team
FAQ
Contact Us

Companies
Our Team
FAQ
Contact Us

Get a Quote

Companies
Our Team
FAQ
Contact Us

Companies
Our Team
FAQ
Contact Us

Request a Quote

Get Your Free Quote Today

Please fill out one of the forms below and click submit at the end of the form for your free insurance quote. All personal information provided is strictly confidential and will not be sold to any third parties. All quotes will be completed on a timely basis. You will receive the requested insurance quote by phone or email.

Auto Insurance

Home Insurance

Mobile Home Insurance

Motorcycle Insurance

Renter's Policy

Auto Insurance

Auto Insurance

Current Auto Insurance?

Yes

No

How long continuous?

Lapsed?

Yes

No

When?

MM slash DD slash YYYY

Name

Date

MM slash DD slash YYYY

Home Phone

Cell Phone

Email(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Rent or Own

Rent

Own

If not currently insured, how long owned?

Number in household

Prior address if recently moved:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Member/Spouse

Member/Spouse Date of Birth

MM slash DD slash YYYY

Other household members

Name

Age

Excluded?

Yes

No

Ins. in force?

Yes

No

Medical Ins. covering all household members?

Yes

No

With whom?

Vehicle #1 – Year

Vehicle #1 – Make

Vehicle #1 – Model

Vehicle #1 – VIN

Driven to work?

Yes

No

Untitled

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

How far one way?

Business/Artisan use?

Driver Name

Married?

Yes

No

Occupation

How is vehicle titled?

DL#

Vehicle #2 – Year

Vehicle #2 – Make

Vehicle #2 – Model

Vehicle #2 – VIN

Driven to Work?

Yes

No

Days driven to work

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Limit

How far one way?

Business/Artisan use?

Driver name

Married?

Yes

No

Occupation

How is vehicle titled?

DL#

Prior Bodily Injury Limit

Bodily Injury

Uninsured Motorist Limit

Medical Ins. covering all household members?

Yes

No

With whom?

Comprehensive Deductible

Collision Deductible

Towing?

Yes

No

Limit

Rental Reimbursement?

Yes

No

Limit

Additional Notes

Δ

Home Insurance

Home Insurance

Date

MM slash DD slash YYYY

Name

Home Phone

Cell Phone

Email(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Location (if different)

Currently insured?

Yes

No

If not currently insured, how long owned?

Year Constructed

Number of stories

Square footage

Type

Stick built

Manufactured home

Brick/Brick veneer

HUD or BOCA rated

Crawl Space or Basement?

Crawl Space

Basement

Basement Type

Basement – Full

Basement – Partial

Basement – Finished

Basement – Unfinished

Any additions? (porches, living space, etc.)

Type of siding

Type of roofing

Deck?

Yes

No

What size?

Porch?

Yes

No

What size?

Garage?

Yes

No

Garage Type

Detached

Attached?

How many cars?

Any other outbuildings?

Increased outbuilding coverage needed

Primary heating source

Woodstove?

Yes

No

Where is stove located?

Type of chimney

Any double venting?

Fireplace?

Yes

No

Where located?

Number of baths

Year of updates – Heating

Year of updates – Plumbing

Year of updates – Wiring

Year of updates – Roofing

Year of updates – Siding

Water backup/Sump pump coverage needed?

Yes

No

Dwelling coverage amount on current policy

Personal liability

Medical payments

Deductible requested

Primary Home?

Yes

No

Type

Seasonal

Secondary

Insured's date of birth

MM slash DD slash YYYY

Non-smoker credit?

Yes

No

Smoke detectors?

Yes

No

Fire Extinguishers?

Yes

No

Deadbolt locks on all doors?

Yes

No

Age and breed of dogs

Breed

Age

Farming or livestock on premises?

Δ

Mobile Home Insurance

Mobile Home Insurance

Date

MM slash DD slash YYYY

Name

Home Phone

Cell Phone

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Location (if different)

Currently insured?

Yes

No

If not currently insured, how long owned?

Year

Make

Square footage

Any additions? (porches, living space, etc.)

Type of siding

Type of roofing

Deck?

Yes

No

What size?

Porch?

Yes

No

What size?

Garage?

Yes

No

Garage Type

Detached

Attached?

How many cars?

Any other outbuildings?

Increased outbuilding coverage needed

Primary heating source

Woodstove?

Yes

No

Where is stove located?

Type of chimney

Any double venting?

Fireplace?

Yes

No

Where located?

Number of baths

Year of updates – Heating

Year of updates – Plumbing

Year of updates – Wiring

Year of updates – Roofing

Year of updates – Siding

Water backup/Sump pump coverage needed?

Yes

No

Dwelling coverage amount on current policy

Personal liability

Medical payments

Deductible requested

Primary Home?

Yes

No

Type

Seasonal

Secondary

Insured's date of birth

MM slash DD slash YYYY

Non-smoker credit?

Yes

No

Smoke detectors?

Yes

No

Fire Extinguishers?

Yes

No

Deadbolt locks on all doors?

Yes

No

Age and breed of dogs

Breed

Age

Farming or livestock on premises?

Δ

Motorcycle Insurance

Motorcycle Insurance

Effective Date Needed

MM slash DD slash YYYY

Name

Birth Date

MM slash DD slash YYYY

Age

Home Phone

Cell Phone

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Marital Status

Single

Married

Motorcycle License?

Yes

No

Cycle Safety Course

Yes

No

Date of course

Years Motorcycle Experience:

Prior Bodily Injury Limit

Bodily Injury:

Uninsured Motorist Limit

Medical Ins. covering all household members?

Yes

No

With whom?

Comprehensive Deductible

Collision Deductible

Do you belong to any motorcycle clubs or organizations?

Have you had previous motorcycle insurance on ANY motorcycle in the past 6 months?

Yes

No

What company?

Exp. Date

MM slash DD slash YYYY

Motorcycle

Year

Make

Model

CC

Value

Δ

Renter's Policy

Renter’s Policy

Name(Required)

Home Phone

Cell Phone

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Of Birth

MM slash DD slash YYYY

Limit on Personal Property:

Deductible Requested:

Δ

4 Locations to Serve You:

Decatur
Paw Paw
Marcellus
Bangor

123 S. Phelps Street
Decatur, MI 49045

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