Request Home-Owner Quote

Please complete the following information if you would like to obtain a proposal on Homeowners Insurance. Once received we will contact you by phone. Please understand this is not an application for insurance nor does it bind any coverage. An application will be sent to you if coverage is desired.

All of the information provided is confidential and will be used solely for the purpose of developing a proposal for you. The home may be a single family owner occupied dwelling (home), condo or town home. This program may provide (A) dwelling fire coverage, (C) contents (personal property), (D) loss of use, (B) separate structures such as a detached garage or shed, (E) premise medical and premise liability insurance.

Complete this form to get a proposal on a single family owner occupied home, condo or townhouse.

Personal Information (required)
What is your name?	First Middle Last
What is your mailing address?	Street City State Zip
What is your telephone number?	Home Work
What is your fax number?
What is your email address?

Property Information
What is the property address?	Street City State Zip
What is the dwelling type?
How many bathrooms are there?
How many fireplaces are there?
How many porches or docks are there?
Approx. sq. ft. of porches or docks?
What year was it built?
How long have you lived at this address?
What is the construction type?
How many stories?
If two stories, what is the ground floor square footage?
What is the square footage of the building?
What is the square footage of the building above ground?
What foundation type?
If structure is located in a flood zone, what is the distance to the body of water?
What type of garage?
What type of roof?
Was the roof updated?	Yes No
If “yes”, what year??
Does the building have a pool?	Yes No
If there is a pool, is it fenced?	Yes No
If there is a pool, is there a diving board?	Yes No
If there is a pool, is there a slide?	Yes No
What is the distance of fire protection?
Is there a smoke alarm?	Yes No
Is there a fire extinguisher?	Yes No
Are there deadbolts?	Yes No
Is the electrical updated?
Are there circuit breakers?	Yes No
Does the electrical circuit box have copper wiring?	Yes No
How old is the heating/air conditioning?
Is the heating/air conditioning thermostatically controlled?	Yes No
What is the energy source?
What is the heating system?
What is the cooling system?
Has the plumbing been updated?	Yes No
Is there a theft alarm?	Yes No
Is there a fire alarm?	Yes No
What is the name of the responding fire dept.?
Are there dogs on the property?	Yes No
If yes, how many and what is the breed of each dog?
Are there any other pets/animals on the property?	Yes No
If yes, how many and what is the description of each?

Current Coverage Information
What is your current insurance?
What is the expiration date of current policy?
Were there any losses or claims in the last 5 years?	Yes No
If yes, what is the date, amount paid and description of each loss or claim?

Desired Coverage Information
Dwelling amount
Other structures
Business property
Loss of use
Premise liability?
Policy deductible?
Do you want building replacement cost coverage?	Yes No
Do you want contents replacement cost coverage?	Yes No
Questions or comments?

Best Time to Contact You
Please let us know the best time to call and discuss your quote	Morning Afternoon Evening Anytime
Or, please specify another time

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Larkin Agency of Traverse City | 3963 W Royal Dr | Traverse City, MI 49684 | Phone: (231) 947-8800 | Email: admin@larkingrp.com

Larkin Group — Northern Michigan Insurance and Financial Specialists located in Traverse City and Leelanau

Request Home-Owner Quote

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