Lake Agency Serving Your Insurance Needs Since 1946
Call: 800.225.5960
810.694.2050
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Home Owners Insurance Quote

Please fill out the sections below so we can contact you with your quote:

* Indicates required fields

Applicant(s) Information
* Name of Applicant:
* Date of Birth:
Name of Spouse:
Spouse Date of Birth:
* Address:
* City:
* State:
* Zip Code:
Do you or your spouse belong
to any associations or special groups? 		Yes    No
If yes, please list them:
Requested Coverages / Limits
What amount is your home
currently insured for?
 		 $
 
Coverage for contents (personal property):
Standard limit is a percentage
of the limit for the home
  		$
 
What deductible would you like?
  		 
 
Other Structures:
The standard limit for sheds, detached garages, and outbuildings is a percentage of the limit of the home. If you would like a specific limit quoted, please indicate below.
  Description Desired Limit
1  
2  
3  
4  
5  
What limit of liability
coverage would you like?
Do you want water/sewer backup?
Special Coverages/Limits
Do you own any jewelry, furs, or fine arts that you wish to insure?
  Description Desired Limit
1 $
2 $
3 $
4 $
5 $
Do you own any cameras, computers, or special equipment that you wish to insure?
  Description Desired Limit
1 $
2 $
3 $
4 $
5 $
 
Do you require the increased liability protection of a personal Umbrella?
Do you have any secondary vacation
homes that require coverage?
If so, please describe briefly:
Additional Information
Have you had any claims
in the past three years? 		Yes    No
If yes, please describe:
Is the home occupied by the owner? Yes    No
If no, please describe:
Approximately what year
was your home built?
What is the square footage of your home? sq. ft.
What is the construction of your home? Brick    Frame
Please estimate the market
value of your home: 		$
Is there a fire hydrant within
500 feet of your home? 		Yes   No
Please estimate the distance
to the nearest fire station: 		miles
Do you have a central burglar alarm? Yes    No
If yes, what company?
Do you have smoke detectors? Yes    No
If yes, how many?
Do you have fire extinguishers? Yes    No
Do you have deadbolt locks
on all exterior doors? 		Yes    No
Are there any smokers
living in the household? 		Yes    No
Are there any dogs or
exotic pets on the premises? 		Yes    No
If yes, please describe:
Do you have a pool?
Is the pool fenced? Yes    No
Do you have a hot tub? Yes    No
Do you own a trampoline? Yes    No
Is your yard fenced? Yes    No
Do you own or operate a business
on the premises?		 Yes    No
How would you like to be contacted with your quote?
Telephone:
E-mail:
Fax:
Postal Address: Send me a quote by U.S. Mail to the address given above.
Additional comments or questions:
After completing the above form, please click the Get a Quote button once. Thank you.
        
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