February 17, 2019
About Tawas Bay
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Homeowner's Quote
Policy Holder
Contact Name *
Email *
Phone Number *
Property Location
Address *
City *
State *
Zip *
County *
Current Insurance Information
Company Name *
Current Annual Premium
Expiration Date
Deductible Desired *
$100
$250
$500
Amount of Liability
$100,000
$200,000
$500,000
$1,000,000
Earthquake Coverage Desired?
Yes
No
Have you filed for bankruptcy within the past 7 years?
Yes
No
Dwelling Information
Estimated Replacement Cost
Square Footage *
Year Constructed *
How Many Floors? *
1 Story
1.5 Story
2 Story
Bi-Level
Tri-Level
Other
Type of Construction
Wood
Stucco
Masonry
Brick Veneer
Aluminum Siding
Other
Other Features *
Dead Bolts
Smoke Detectors
Fire Extinguisher
Central Station Fire Alarm
Central Station Burglar Alarm
Home Located within 5 miles of Fire Station
Home Located within 1000 feet of a Fire Hydrant
Swimming Pool
Trampoline
Home located within City Limits
Claims
List any claims in past 3 years:
Amount Paid
Claim Type
Description
1.
2.
3.
Personal Property
Estimated value of your personal property:
Jewelry & Watches
Furs
Silver
Firearms
Stamp and Coin Collections
Fine Arts and Breakable Items
* = Required Field
Disclaimer Notice
- The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.
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