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Great Northern Insurance Agency
Our Dedication Ensures Your Satisfaction

CALL NOW 248-856-9000

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Insurance
Free Quotes
Service Center
Calculators
Contact Us

Insurance
Free Quotes
Service Center
Calculators
Contact Us

Homeowners Quote

Our process is transparent

For Help Call 1-(248)-856-9000

Fields marked (*) are mandatory

FIRST NAME

MIDDLE NAME

LAST NAME

HOME PHONE

WORK PHONE

E-MAIL

REFERRED BY

PRIOR INSURANCE

Fields marked (*) are mandatory

HAVE PRIOR INSURANCE

IF OTHER INSURER IS SELECTED ENTER INSURER NAME

HAVE INSURANCE WITH THEM FOR

ESTIMATED YEARLY PREMIUM (IN US$)

PRIOR POLICY ENDS ON

PROPERTY GENERAL

ADDRESS 1

CITY

STATE

ZIP CODE

PROPERTY SURROUNDINGS

DISTANCE TO FIRE STATION

DISTANCE TO HYDRANT(FT)

Under 1000 Over 1000

YEAR BUILT

PROPERTY USE

SQUARE FOOTAGE

NUMBER OF FAMILIES

NUMBER OF STORIES

DOG TYPE

PROPERTY VALUES

PURCHASE DATE

PURCHASE PRICE

EST. CURRENT MARKET VALUE

EST. REMPLACEMENT VALUE

CONSTRUCTION DETAILS

Fields marked (*) are mandatory

CONSTRUCTION TYPE

ROOFING MATERIAL

AGE OF ROOF

ELECTRICAL TYPE

HEAT TYPE

NUMBER OF FIREPLACES

NUMBER OF BATHROOMS

PROTECTION DEVICES

BURGLAR ALARM

FIRE ALARM

SMOKE DETECTORS

FIRE EXTINGUISHERS ON EACH FLOOR

Yes No Not Sure

FIRE SPRINKLER SYSTEM

BUILDING DETAILS

NUMBER OF BASEMENTS

BASEMENT SQ. FOOTAGE(EST.)

BASEMENT FINISHED PERCENTAGE(EST.)

GARAGE TYPE

GARAGE SQ. FOOTAGE (EST.)

OTHER STRUCTURES

SWIMMING POOL TYPE

SWIMMING POOL FENCE CONSTRUCTION TYPE

HAS DIVING BOARD

Yes No

APPLICANT INFORMATION

Fields marked (*) are mandatory

DATE OF BIRTH

MARITAL STATUS

YEARS AT CURRENT ADDRESS

YEARS AT PREVIOUS ADDRESS

OCCUPATION

YEARS WITH CURRENT EMPLOYER

YEARS WITH PRIOR EMPLOYER

SSN#

RATE YOUR CREDIT

CO-APPLICANT (SPOUSE) INFORMATION

RELATIONSHIP TO APPLICANT

FIRST NAME

LAST NAME

DATE OF BIRTH

OCCUPATION

YEARS WITH CURRENT EMPLOYER

YEARS WITH PRIOR EMPLOYER

SOCIAL SECURITY NUMBER

ADDITIONAL INFORMATION

The questions bellow will help the Insurers to determine the best discounts to be awarded

HAVE YOU HAD ANY REPORTED LOSSES DURING THE PAST 3 YEARS?

Yes No

ANY BUSINESS CONDUCTED ON PREMISES? (INCLUDING DAY/CHILD CARE)

Yes No

ANY RESIDENCE EMPLOYEES?

Yes No

HAS APPLICATION HAD A FORECLOSURE, REPOSSESSION OR BANKRUPTCY DURING THE PAST FIVE YEARS?

Yes No

DOES APPLICANT OWN ANY RECREATIONAL VEHICLES (SNOWMOBILES, DUNE BUGGIES MINI BIKES ATVS, ETC.)?

Yes No

DOES APPLICANT OWN ANY RECREATIONAL VEHICLES (SNOWMOBILES, DUNE BUGGIES MINI BIKES ATVS, ETC.)?

Yes No

IS BUILDING RETROFITTED FOR EARTHQUAKE?

Yes No Not Sure

BASIC COVERGES

Fields marked (*) are mandatory

PERSONAL LIABILITY

MEDICAL PAYMENTS

DEDUCTIBLES

ALL PERILS DEDUCTIBLE

CREDITS

NON-SMOKING HOUSEHOLD

Yes No

Products

Services

Locations

Products

Auto Quote
Homeowners Quote
Condominium insurance
Renters Insurance
Commercial Auto
Business Owners (BOP)
General Liability
Inland Marine
Liquor Liability

Services

Change Address
Add Vehicle
Delete Vehicle
Change Vehicle
Add Driver
Delete Driver
General Auto Request
File Auto Claim
General Home Request
File Property Loss

Locations

Main Office
ISU-Great Northern Insurance Agency 39850 Van Dyke Ave Sterling Heights , MI 48313
Phone:248-856-9000
Fax:248-856-9001
California Office
Kevin Lam 1900 Camden Ave San Jose, CA 95124
Phone:(408) 444-5196
Fax:(877) 275-1639
Ann Arbor Office
Kristine Reed PO Box 3306 Ann Arbor, MI 48106
Phone:(734)945-0027
Phone2:(248)856-9000
Fax:(248)856-9001

Great Northern Insurance Agency Our Dedication Ensures Your Satisfaction

Homeowners Quote

Our process is transparent

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Locations

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Great Northern Insurance Agency
Our Dedication Ensures Your Satisfaction