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Online Landlord's Insurance
Quote Request Form
One Simple Form - takes only 2-3 Minutes!


 
Your Name:
Business Name:
Property Address:
City:
State:
Zip/Postal:
E-Mail (REQUIRED):
E-Mail
(again for accuracy):
Phone:
Fax (optional):
 
 
Dwelling Information
 
Year Building Built:
Building Square footage:
 
Occupancy: Owner Tenant
 
Occupancy Type:
(describe entities & and number of units, such as "4 unit apartment" or "2 offices and barber shop", etc.)
 
Type foundation: Slab
Crawlspace over slab
Pier & Post
Other (list in remarks)
 
Type finished basement, if any: None Full
25% 50% 75%
 
Type Roof: Shingle Wood Shake
Tar/Gravel Spanish Tile Metal Other
 
Type of Siding Brick   Vinyl
Wood   Aluminum
 
Number of stories: One Two
Three 4 or more
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
 

 
Coverages:
 
Building Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Other Coverage/Remarks
(describe any extra coverages needed such as business interruption, robbery, computers, etc.):
 
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Thank you for visiting the insurance web site of Troyer Insurance Agency, Inc.
E-Mail: troyerinsurance@aol.com   |   More About our Agency's Services
1015 N. Nottawa Street   Sturgis, MI 49091   (Click for Map/Directions)    |    Phone: 269-651-9060
Toll Free Phone: 800-617-9060    |    Fax: 269-651-5253   |    © 2007 Insurance-Web-Sales
Privacy Notice/Copyright Info.    |   Questions/site-related problems, please E-mail us at: troyerinsurance@aol.com