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HOMEOWNERS/CONDO/RENTAL
APPLICATION

We at Hudson & Muma/Insure-all.Com believe that it is important to offer our customers
the most up-to-date technology available which will enhance the service they receive.

We could offer you a "quick quote" online and then give you a price and even give you a certificate - you know, like those commercials on TV?!  So why don't we?

The answer is that without ALL the proper information NO ONE can offer you instant coverage.  What do those guys on TV do?  Simple, they give you one price and then come back later on and correct the policy with the information they gather AFTER they have your deposit!  Then you get a bill for the difference!  Nice huh?  Well, we don't do that.  Getting the proper coverage at the best price takes accurate information.

It is because of this commitment that we are offering this form to aid in generating
accurate applications and forms quickly and efficiently!




SUBMITTING THIS FORM YOU ARE AGREEING TO THE CONDITION THAT NO MATERIAL CHANGE WILL BE MADE TO YOUR POLICY UNLESS AND UNTIL YOU RECEIVE CONFIRMATION OF THAT CHANGE FROM A HUDSON & MUMA ASSOCIATE OR AN ASSOCIATE THAT THE INSURANCE COMPANY WRITING THE COVERAGE. 
 * Indicates required fields

 


MICHIGAN

Home Owners Insurance
Information Request Form

Basic Address Information

Name:

Address:

City:

State:

Zip:

Previous Address
(if moved within the last 60 days or if home is
a new purchase)

Prev. Address:

City:

State:

Zip:

Home Phone:

Business Phone:

Cell Phone

E-mail:

Fax:

Birth Date:

Occupation:


Spouse's Name:

Spouse Birth Date:

Spouse Occupation:

PROPERTY INFORMATION

PROPERTY ADDRESS(if different from above):

Address:

City:

State:

Zip:

Construction Type:

Exterior Wall Material:

If Exterior type/material not listed, describe:

Roofing Material:

If Roofing material not listed, describe:

Type of Residence:

Number of Families: Number of Stories:

If Condo or Apartment:      

Number of Units      Number of Stories

Property used as:  Primary Dwelling      Secondary Dwelling    Seasonal Dwelling

Year Built:          Fire Hydrant Within 1,000 ft.?:       Yes No

Square Footage Excluding Basement:    

Foundation Type:

Walk-Out Basement: Yes No

Replacement Cost:    Market Value:

Home Updates

Indicate Year:     Plumbing     Heating      Electrical     Roof

Home Features

Yes No

Attached Garage

# of Cars

 

Construction Type

Yes No

Carport

# of Cars

 

Construction Type

Yes No

Finished Basement

Square Ft:

Yes No

Air Conditioning

If Yes, Type:

Yes No

Room Addition

Square Ft:

Describe:

Yes No

Breeze Way

Type: 

Yes No

Porch

Square Ft:

Describe:

Yes No

Balcony

Square Ft:

 

Yes No

Deck

Square Ft:

 

Yes No

Fireplace 

How Many:

Type:

Insert: Yes No

Yes No

Extra Fireplace

Same Chimney?:
  Yes No

 

 

Number of Bathrooms

# Full Baths

# Half Baths

Yes No

Smoke Alarms

How many?

Yes No

Fire Extinguishers

How many?

Yes No

Dead Bolt Locks

How many?

Yes No

Burglar Alarm

Type:

 

Alarm Service Co:

Yes No

Swimming Pool

Type:

Yes No

Dog

Breed:

Flooring Type:
Hardwood
 Percent: %  
 
Carpet
 Percent: %  
 
Ceramic
 Percent: %  
 
Vinyl
 Percent: %  

Yes No

Wood Burning Stove

 

 

Built-Ins:

    Describe:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPECIFIC ITEMS AND
"SCHEDULED ITEMS"

Do you need a seperate Jewelry Limit? Yes No *
    Amount of coverage needed:

Do you need a seperate Silver Limit?   Yes No *
    Amount of coverage needed:

Do you own handguns or rifles?   Yes No *
    Amount of coverage needed:

Do you have any valuable works of art?  Yes No *
    Amount of coverage needed:

Computer Equipment?   Yes No
    Amount of coverage needed:

Any other "collections" which you would like insured seperately?  Yes No *
    Describe Collection:    
    Amount of coverage needed:

* these items will need to be listed with serial numbers, values, and
current appraisals if applicable.

Additional Coverages Desired:





LIABILITY COVERAGE DESIRED

Liability Limit Desired:

Current Insurance:

Current Insurance Company:

            Policy Number:    Expiration Date:

Has Your Insurance even been Cancelled or Non-Renewed?   Yes No
            If Yes, Why?

List any claims that you've filed within the last three years:






 

Confirmation Email Address:
(We need this to send you a confirmation receipt for this form. See our Privacy Policy HERE)

 

 

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