Mid-Michigan Insurance Agency of Mt. Pleasant, Inc.

Name (including spouse)
Location address
Phone number:
E-mail address
Township
County
Mailing address (if different)
Type of home
If it's modular, is it:
Year home was built
Total square feet
List all updates and additions and year completed
Number of stories
Type of basement:
If it's a trailer, is it on a permanent foundation?	Yes No
List trailer make, model and serial number
Is the house?
Is the roof?
Current insurance company
Liability limits	300 500
Current deductible
What is the value of the dwelling
List any claims in the last 5 years
How many household members are there?
Owner #1's occupation
Owner #2's occupation
Does anyone in the house smoke?	Yes No
Is there a trampoline?	Yes No
Is there a pool, pond, or hot tub?	Yes No
If yes, is it fenced?	Yes No
Any of the following windows?	Bay Bow Picture
Any of the following doors?	Sliding Glass French
Type of walls and ceilings ( drywall, tongue and groove...)
Number of full bathrooms
Number of half bathrooms
Is there a garage?
Size of garage
Any other buildings on the property?
Are there smoke detectors?	Yes No
Is there a central alarm system?	Yes No
Is there a deck or patio?	Yes No
Are there skylights?	Yes No
Is there air-conditioning?	Yes No
Is there a woodstove / corn burner?	Yes No
Is there a fireplace?	Yes No
If yes:	Chimney Gas
List any pets or animals
List memberships to credit unions, alumni or other groups
How would you prefer to be contacted?
If contact is by phone, what is the best time to reach you?

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