George Papazoglou
Phone: 734-637-0666
Fax: 866-597-4818
george@miinsurancebrokers.com
www.miinsurancebrokers.com
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Home Quote Form

 
Name of insured & DOB?
Spouse name & DOB if applicable?
Address?
How many years in current address?
Year built?
Square footage?
How many Full/Half bathrooms? ____/____
Exterior Wall: Brick, Vinyl, etc:
Style of Home: Ranch, Colonial, etc:
Garage: No garage, Attached or Detached? 0, 1, 2, 3, 4 cars?
Full basement? Is it finished?
Fireplace? Gas or Natural? How many?
Heat source (Furnace/Electric/Boiler)?
Fuses or circuit breakers? At least 100A service?
Porch or Deck? If yes what size?
Pool or Trampoline?
What year did you purchase your residence? Is it a Home or Condo?
Local or Central Alarm system?
Is Any updates to Roof/Furnace/Electrical/Plumbing? What years?
When does your current policy expire?
Current premium?
Current home insurance carrier and how long of continuos coverage?
Email address?*
Telephone#?*
Comments/Additional Info:*
* For an accurate quote all questions/Fields
must be answered.
 
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