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Homeowners Insurance Quote


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information
First Name
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Last Name
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Street
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City
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State
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ZIP / Postal Code
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Primary Phone Number
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E-Mail Address
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Prior Address If Moved in Last 6 Months
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Date(s) of Birth for Proposed Insured Person(s)
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Current Insurance Company
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Current Policy Expiration Date
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Current Premium
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How did you hear of our agency?
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If by referral, who referred you?
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Why are you shopping?
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Tell us how we can best meet your needs!
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Add notes here:
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General Information
Year Home Built
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Township
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Approximate market value of home:
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Within 5 miles of fire department?
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Within 1,000 feet of a fire hydrant?
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Any smokers in the household?
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Do you have any financing on your house?
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Age of roof
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Any claims in the last 5 years?
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Select group discount
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List any other groups you belong to
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Check all of the items you have:
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Coverage Information
Dwelling limit:
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Other Structures limit:
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Personal Property limit:
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Loss Of Use limit:
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Personal Liability limit:
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Medical Payments To Others limit:
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Deductible
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Select Additional Coverages desired:
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Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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Boer Insurance Group | 2535 Five Mile Road NE, Grand Rapids, MI 49525 | Ph: 616-363-7766 | Fx: 616-363-6626
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