Mapes Insurance
Home Owners QuickQuote
Fill out our online quote form to have an insurance specialist contact you with the best possible rate.
Personal Information
Name:
Address:
City:
State: (Michigan only)
Zip:
Telephone:
Email Address:
Date of Birth:
Insurance Information
Are you currently insured? If yes, what is your renewal date?
Amount of insurance on home? $
Liability Limit? Deductible?
What year was home built?
Have you made any updates to your home? Roof Furnace Plumbing Electrical
Do you have a hot tub? Yes No Do you have a trampoline? Yes No
Does anyone in house smoke? Yes No Do you have a woodstove? Yes No
Do you have smoke dectectors? Yes No Do you have a fire extinguisher? Yes No
Do you have dead bolt locks? Yes No
Do you have fire hydrants? Yes No
If yes, are they within 1000 ft of home? Yes No
Do you have pets? Yes No
If yes, do they have a biting history? Yes No
Do you have a pool?
If yes, do you have any of the following? Fence Slide Diving Board
Is the home vacant? Yes No
Is this your primary residence? Yes No
Which fire department would respond?
Valuables
Do you have any boats or snowmobiles? Please list.
  RV 1 RV 2 RV 3 RV 4
Year:
Make:
Model:
Value: $ $ $ $
Do you have any jewelry or furs?
  Item 1 Item 2 Item 3 Item 4
Description:
Value: $ $ $ $
General Information
Any Claims within the last 5 years?
(Please list.)
Are you a member of any group?
(Example: Sam's Club, MEA, AARP, College Alumni)?
 
 
Mapes Insurance Agency
P.O. Box 1824
2032 Lake Michigan Drive N.W. Grand Rapids, Michigan 49501-1824
Phone: (616)453-8600 Fax: (616) 453-8391
Toll Free: (888)457-3147
 
Copyright © 2005 Mapes Insurance Agency