• Home
• Products/Services
• Claims Information
• About Us
• Companies
• Resources
• Get-A-Quote
Mike Kirgis Insurance Agency
616-527-1010
Now you can apply online direct with us! Please fill out the form below to receive the most accurate homeowner's insurance quote. If you are looking for a quote on automobile insurance,
please click here.
HOMEOWNERS INSURANCE QUOTE FORM
Customer Info:
Name:
Telephone:
Email Address:
(Required)
Address:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
Age of Insured:
All members of household non-smokers?
Yes
No
Dwelling Info:
Year Built/Age of Home:
/
Exterior Wall Construction:
Yes
No
Number of Stories:
Total Square Footage:
Substructure:
Select One
Basement
Slab on ground
Crawlspace
If you selected Basement is it:
Select One
Finished
Unfinished
Amount of coverage:
If new purchase, amount of mortgage:
Replacement Cost:
Deductible
Select One
100
250
500
Liability:
Select One
100,000
300,000
500,000
Fireplace:
Yes
No
If yes how many?
If yes w/chimney?
Yes
No
Woodburner:
Yes
No
Air Conditioning:
Yes
No
If yes select one
Select One
Central
Unit
Deck or porches:
Select One
Deck
Porches
If yes what is the size?
Burglar or Fire Alarms?
Yes
No
If yes select one
Select One
Local
Central
Baths
Select One
Full
Half
Smoke Alarms:
Yes
No
If yes how many?
Fire Extinguishers:
Yes
No
If yes how many?
Deadbolt Locks?
Yes
No
Additional Info:
Garage:
Yes
No
#Car:
Select One
Attached
Detached
Any other structures on property:
Yes
No
Amount of coverage:
Miles to Fire Department:
Fire Hydrants?
Yes
No
Distance from hydrant:
Is house visible by 5 other houses?
Yes
No
Swimming Pool?
Yes
No
If yes is it
Select One
In-ground
Above ground
And is it Fenced in
Yes
No
Trampoline?
Yes
No
