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Last Edited: 10/02/2011

Homeowners Quote

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Special Offer

To make your home easy to find by EMS services, Schmitz Insurance is now offering EZ View Solar House Numbers FREE with every new Homeowners Policy

Units can also be purchased at Schmitz Insurance offices

Homeowners Quote

Last Name

First Name

Address 1

Address 2

City		State		zip

Primary Phone

Address of property to be insured

City		State		zip

Property Type

Year Built

* Name of your current insurance company: (If you are just now purchasing this property, select: "None-Purchasing Now" or select your current insurance company that you use for your current home)
* Current Policy Expiration/Renewal date: (If you are not sure, you can describe when. Example: "within the next month", "within the next two weeks", "next week" , etc. )
* How long have you been with your current insurance company?	years months
Estimated Value of Home:
Style of Home:
Dimension of home
Number of Livable Square Feet
Type of Heating system
Number of bedrooms:
Number of bathrooms
Approximate distance from the Fire Station:
Approximate distance from Fire Hydrant
Type of siding
Type of garage
Type of roofing		Aprox. Age
Type of Foundation
Sewer Type	Municipal	Septic Tank
Type of flooring and aprox. percent of each
Hardwood	%
Tile	%
Carpet	%
Property Accessories: (check all that apply)

Smoke Dectector	Central Burgular Alarm	Covered Deck
Fire extinguishers	Manned security	Non-Covered Deck
Central Fire Alarm	Deadbolt Locks	Swimming Pool
Fireplace	Air Conditioning	Trampoline
Escape Windows	Wood Burning Stove	Illuminated Address Numbers

How much property (entire residence) coverage do you want? (example: $250,000 or the value of your home)

How much personal property contents coverage do you want? (example: $50,000 or the value of your personal possessions

How much personal liability coverage do you want?

How much deductible?

Are you interested in combining your auto and homeowners insurance for a mulitple-policy discount?

Yes No

Additional Coverage:

Sewer & Water Backup

Yes No

Refrigerated Products Coverage

Yes No

High Value Items : Jewelry Guns Art

Other List

Number of claims in the past 3 years:

If applicable, describe any claims (give dates and estimate amount paid) and any other information you wish us to know in order to process this quote:

Mortgagee

Please pick what best describes your credit rating:

Grandin ND

(701) 484-5555
800-690-5556
Fax: (701) 484-5521

Finley
(701) 524-2222
Toll Free 877-690-5556
Fax (701) 524-2011

Fargo
(701) 364-5555
Toll free 866-690-5556
Fax: (701) 356-1033

Stephen, MN
(218) 478-2845
Toll free 855-690-5556
Fax: (218) 478-2846

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