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TroyerInsurance.com insurance expert Brian Taylor
Hello, I'm Brian Troyer, 2nd
generation owner of Troyer
Insurance. I started in our
family agency in 1994. It is
my goal to provide you with
outstanding customer service.
I welcome you to give me a call,
and I will make you another
satisfied member of our
insurance family.

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Your Personal Data
 
Your Name:
Property Address:
City:
State:
Zip/Postal:
E-Mail (REQUIRED):
E-Mail (again for accuracy):
Phone:
Fax (optional):
 
Dwelling Information
 
Year Dwelling Built:
Home Square footage:
 
# Units in common bldg.:
 
Type Roof: Shingle Wood Shake
Tar/Gravel Spanish Tile
 
Number of stories: One Two
Three 4+
 
Do you own animals or pets? Yes No
If yes, list type/for dogs, list breed:
 
Are You Near Brush Area? Yes No
 
# 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)
 
Circuit Breakers or fuses? Breakers Fuses


# Fireplaces: # Chimneys:
 
Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)
 
Coverages:
 
Contents $ Loss of Use $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):
 
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Troyer insurance agency
 
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
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