MEA homeowners request for quote quotation

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Take Advantage of the Benefits Offered by Citizens Insurance Company of America

Request A Homeowners Insurance Quote

To request a quotation for homeowners insurance complete our request form. Our agency is licensed to sell auto and homeowners insurance only to residents of Michigan.

MICHIGAN ONLY !

Tell Us About Yourself
.First Name
.Middle Initial
.Last Name
.Date of Birth
.Marital Status
.Spouse's Name
.Spouse's Date of Birth
.Home Address .No Post Office Boxes
.City
.Township
.County
.Zip Code
.Home Phone
.Business Phone
.Employer's Name
.Employer's City
.Membership Type?
.Other Professional Association(s)?
.Present Insurance Company for Auto
.Expiration Date
.Present Insurance Company for Homeowners
.Expiration Date or Closing Date
.If You Have Automobile Insurance thru .MEA Financial Services with any of our .Companies,please advise policy number.
.Have you moved more than twice in the past 7 years?	Yes No
.Do you currently rent or own your home?	Rent Own
.Is the home to be insured a condo or a house?	Condo House
.Is this your primary or secondary i.e. cottage dwelling?	Primary Secondary
.Is the home for sale?	Yes home is for sale Home is not for sale
.Is your current policy being non-renewed?	Policy is being non-renewed No, policy is not being non-renewed

Homeowners Information

If location of home to be insured is different from your mailing address, check the box and give actual location of home below:

.Home Address .No Post Office Boxes
.City
.Township
.County
.Zip Code

.Requested Deductible Amount (e.g. $100, $250)
.Building Construction
.If building construction .is a mixture of frame and .masonry, give % of each.	Frame Masonry
.Distance from Fire Department .(in miles)
.Responding Fire Department .
.Distance from Hydrant (in feet)
.If there is a Police or Fire Alarm, please indicate which. .
.Do all doors have dead-bolt locks?.	Yes No
.Does any resident of household .smoke?	Yes No
.Is house equipped with smoke alarms?.	Yes No
.If yes, how many?
.Does home have woodburning stove?	Yes No
.Location of woodburning stove? .e.g. basement,garage
.Is there fire extinguisher(s) .in home?	Yes No
.If yes, how many?
.List all claims for .the past 5 years .include date, amount paid .and details of claim
.Do you need a rider for .scheduled personal property .e.g. jewelry, furs, guns, .computer,etc.	Yes No
.If yes, list items and .value of each:
.Do you need coverage for .recreation vehicles .e.g. boat, trail bike, atv, .snowmobile,etc.	Yes No
.If yes, list year, description, .HP or CC's, equipment, maximum .speed, cost new and coverage .carried or desired.

.Check and complete the appropriate section below: .If you own a mobile home, call our office at: .517.351.2122 or 800.292.1950

SECTION 1 Complete When Requesting A Homeowners Policy Quote. Also, Complete the Replacement Cost Estimator Below.
.Amount dwelling is currently .insured for:
.Market value of dwelling:
.Liability Limits .e.g. $300,000, $500,000
.Is a business conducted out of the home? If yes, please explain.
.Is there a swimming .pool or any other body .of water on property?	Yes No
.If yes, specify:
.Is there a trampoline on the property?	Yes No
.Is trampoline fenced?	Yes No N/A
.If you own a dog(s),. provide breed(s):
.Has the dog ever bitten?	Yes No N/A

SECTION 2 When Requesting a quote for a CONDO OWNER policy please complete the information below.
.Number of units in building:
.Do you need glass .breakage coverage?	Yes No
.Dollar amount requested for .interior dwelling coverage .e.g. walls, floors, carpet, .appliances, cupboards, .mechanicals, etc.
.Dollar amount requested .for personal property:
.If needed, dollar amount .for loss assessment coverage .(if unsure, please check with .your condo association)

SECTION 3 Complete When Requesting A Renter/Tenant Policy Quote
.Is your rental in a house?	Yes No
.If yes, number of units in house:
.Is rental in an apartment buiding?	Yes No
.If yes, number of units in apartment .building:
.Dollar amount requested .for personal property?

SECTION 4 Replacement Cost Estimator - Complete When 
Requesting A Homeowners Policy Quote.
.Dwelling limits may vary depending upon the finding of the 
.replacement cost estimator.  Dwelling must be insured at 
.100% replacement value to meet the eligibility requirements
.for the deluxe endorsement.

.Approximate year dwelling was built:.
.Total Sq.feet of Home (exclude basement):
.Basement (sq.feet):
.Number of stories:
.Type of foundation:

.If home is over 30 years old, provide year of last update for the following:	Roof: Furnace: Electrical: Plumbing:

.Check the box on the left if the requested information .does not apply to your dwelling. Otherwise, provide .information on the right.

.
.Garage:

Type:

Number of Cars:

Construction:

.If Attic is Finished, Indicate
Sq. Fottage of Finished Area:

.If Basement is Finished, Indicate
Sq. Footage of Finished Area:

Walk-out basement?:

.Central Air Conditioning:

.Attached 3-Wall/Room Addition:

Addition (sq. feet):

Number of Stories:

Construction:

With Basement:

Yes No

.Breezeway:

Type:

Square Feet:

.Porch:

Type:

Square Feet:

.Balconies or Decks:

How many?:

Indicate square feet for each:

.Fireplaces:

Number of Chimneys:

Number of Masonry Hearths:

.Additional Baths:

Additional 1/2 baths (2 fixtures):

Additional full bath (3 fixtures):

.COMMENTS.

Congratulations! You've made it!!
Once you have completely filled-out the request form, click "Send Now". If you receive the message that you missed something, use the back arrow & complete the missing item(s). We will process your request and mail your quotation.

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