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Great Northern Insurance Agency
Our Dedication Ensures Your Satisfaction

CALL NOW 248-856-9000

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Contact Us

Renters Insurance

Our process is transparent

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

PERSONAL INFORMATION

Fields marked (*) are mandatory

NAME

ADDRESS

CITY

STATE

ZIP CODE

PROPERTY ADDRESS (IF DIFFERENT FROM ABOVE)

DAY PHONE

NIGHT PHONE

BEST TIME TO CALL

E-MAIL ADDRESS

OCCUPATION

HOW LONG AT CURRENT JOB

DATE OF BIRTH

SMOKER?

Yes No

CURRENT INSURANCE INFORMATION

Fields marked (*) are mandatory

COMPANY NAME (NOT AGENCY)

POLICY EXPIRATION DATE

PREMIUM AMOUNT

POLICY TYPE

Primary Secondary

TERM

6 Months 1 Year Other

TERM OTHER

HAVE YOU FIELD ANY PROPERTY CLAIMS IN THE PAST 3 YEARS?

Yes No

IF "YES", PLEASE GIVE US CLAIM DETAILS

DWELLING INFORMATION

LIVING AREA SQ FT

NUMBER OF UNITS IN YOUR BUILDING

YEAR BUILT

COPPER PLUMBING?

Yes No

CIRCUIT BREAKERS

Yes No

ALARM SYSTEM

IS THE HOME/APARTMENT EQUIPPED WITH AT LEAST ONE WORKING SMOKOE ALARM?

Yes No

DOES YOUR HOME HAVE AT LEAST ONE FIRE EXTINGUISHER THAT IS 2 1/2 IBS. OR LARGER?

Yes No

DO ALL EXTERIOR DOORS HAVE DEADBOLT TYPE LOCKS?

Yes No

DESIRED COVERAGES

DEDUCTIBLE

COMPREHENSIVE PERSONAL LIABILITY

VALUE OF YOUR CONTENTS ($)

LIST ANY ADDITIONAL COVERAGE REQUIREMENTS

ADDITIONAL COMMENTS

ADDITIONAL COMMENTS

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

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