Home Our Products Our Companies About Us Our Staff Contact Us Service Center Discounts Our Newsletter Karn Sitkins Payette Insurance Agency, Inc. On-Line Customer Service

Homeowners Quote Request Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member. Effective Date: Your Name: Your Mailing Address: Street City, State, Zip      Your Date of Birth: E-mail Address: Daytime Phone #: Choose One: Please call me with quote premium. Please send quote via e-mail. Current coverage: Company:                    Expiration Date:   Type of policy desired: Homeowners Insurance Condominium Insurance Renters Insurance Amount of insurance desired:   Homeowners:  What is the value of your home? Condo/Renters:  What is the value of your personal property?   Valuation: Actual Cash Value Replacement Cost   Valuation: Actual Cash Value Replacement Cost Liability Limit: $100,000 $300,000 $500,000   Medical Payments: $1000 $5000 Deductible: $250 $500 $1000   Property Information: Location: Street City, State, Zip      Check here if same as mailing address. Construction: Frame Masonry Distance to the nearest fire hydrant:  Less than 500 ft. Over 500, under 1000 ft. Over 1000 ft, under 3 miles Over 3 miles Square footage:   County/Township: Year built:   What kind of pets do you have? Number of Stories: Do you use a wood burner? Yes No Foundation: Basement Slab Crawlspace Do you have a swimming pool? Yes No Smoke Detector(s) Installed Home Security System Installed Do you have a trampoline? Yes No   Home Updates:  Enter year updates were made or "unknown": Optional Property Coverages: Roof: Earthquake Coverage Plumbing: Flood Coverage Wiring: Sewer/Water Backup Coverage Heating:   Property Floaters - Indicate limits below: Antiques:   Other Floater Coverage:    Coins:   Description:  Limit of Insurance: Computers: 1. Fine Arts: 2. Furs: 3. Jewelry: Stamps: Tools: Previous Loss Information Please describe any losses or claims filed on your Homeowners Insurance in the last 3 years.  Be sure to include the date of loss, type of loss and the amount of the claim. Additional Comments Please use the box below to enter any additional information you wish to include: If you have not received a response from us within one business day, please contact us again.

Home  |   Products  |   Our Companies  |   About Us  |   Our Staff  |   Contact Us  |   Service Center  |   Claims  |   Payment Options  |   Our Privacy Policy   1420 Ford Avenue   Wyandotte, MI 48192 734-285-5600 • 734-285-6416 Fax   22976 West Outer Drive   Dearborn, MI 48124 313-563-7040 • 313-274-4949 Fax Copyright © 2009 • Karn Sitkins Payette Insurance Agency, Inc. Thursday, September 09, 2010