Partners:

GLP Insurance Services is an independent insurance agency representing many first-rate, premium insurers.

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Locations:
37000 12 Mile Rd., Suite 101
Farmington Hills, MI 48331
248.848.0200
 
 

 

 
 
 

 
Homeowners Quote Request  
Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.
Effective Date:
Your Name:
Your Mailing Address: Street

City, State  Zip
  
E-mail Address:
Daytime Phone #:
Choose One: Please call me with quote premium.
Please send quote via e-mail.
Current coverage: Company:                          Expiration Date:
 
Type of policy desired:
 
Amount of insurance desired:
Homeowners only:
What is the value of your home?

Condo/Renters only:
What is the value of your personal property?
Liability Limit:



Medical Payments:
Valuation of Home:


Personal Property Valuation:
 Deductible:
Property Information:
What is the construction type of your home?
 In what year was your home built?
In what County/Township are you located?
 Distance to the nearest fire hydrant?
What kind of pets do you have?
 Do you have a swimming pool?
Yes No
Do you have a trampoline?
Yes No 		Do you use a wood burner?
Yes No
Smoke Detector(s) Installed
Home Security System Installed
  
Home Updates:  Enter year updates were made. If year not known, enter "unknown":
Roof:


Wiring:
 Plumbing:


Heating:
Optional Property Coverages:
Earthquake Coverage Requested
Flood Coverage Requested
Sewer/Water Backup Coverage Requested
Property Floaters - Indicate limits below:
Antiques:


Coins:


Computers:


Fine Arts:
 Furs:


Jewelry:


Stamps:


Tools:
Other Floater Coverage:     Limit of Insurance:
 
Previous Loss Information
Please describe any losses or claims filed on your Homeowners Insurance in the last 3 years:
Be sure to include the date of loss, type of loss and the amount of the claim.
Additional Comments
Please use the box below to enter any additional information you wish to include:
        
If you have not received a response from us within one business day, please contact us again. Thank you.
 
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