Knabusch Insurance Services, Inc. - Auto Insurance, Home Insurance, Flood Insurance, Life Insurance, Health Insurance

If you would like to receive an Insurance Quote, please complete the form below. Once your information is received we will process the information and then contact you to review your current insurance coverage and premium. Quotes provided for Michigan and Ohio residence only.

Disclaimer: This is not a final quote, nor is it an offer of insurance. Any quote is based only upon the rating information you have provided and may be subject to additional rating variables. This is for informational purposes only. This is not a contract and insurance coverage is not being provided. All information is kept completely confidential.

Your Address Information:
Insured's Name:
Property:
Address 1:
Address 2:
County:
City:
State:
Zip Code:	(5 or 9 digits)
Home Telephone:
Work Telephone:
Email Address:
Preferred Method of Contact:
If Available Block:
Lot:
Parcel:
	- Denotes a required field.
NOTE: All of the following sections must be filled out completely to process this quote.

Rating Information:
Date of Construction:
Replacement Cost:
Substantial improvement date, if it has increased building market value greater than 50%:
Flood Zone:
Community Number:

Building Information:
Type of Building:

Condo Information:
Condo Unit:
Condo Association:
Number of Units:
High Rise (3 or more floors, 5 or more units; not Townhouse or Rowhouse Types)
Low Rise (3 floors or less, less than 5 units; including Townhouse & Rowhouse Types)

Foundation Information:
Number of Stories:
Basement:
Elevated (piers, piles, etc.):
Number of Stories (including Basement):
Slab or Grade:
Elevated (crawlspace):
Crawlspace Ventilation:
Number of Vents:
Total Square Inches of Vents:
Total Square Feet of Enclosure:

Coverage Information:
Deductible:
Building Coverage:
Contents Coverage:
Note: If the structure has been previously insured under the NFIP or another carrier, please fax a copy of the prior policy and the elevation certificate, if applicable.