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Home Owner's
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Dave Aviza Insurance Agency  
517-279-9252  


Now you can apply online direct with us! Please fill out the form below to receive the most accurate automobile insurance quote. If you are looking for a quote on homeowners insurance, please click here.
AUTOMOBILE INSURANCE QUOTE FORM

Customer Info:

 
Full Name:
Phone Number:
Email Address: (Required)
Address:
City:
State:
Zip Code:

Vehicle Info:

 
Vehicle #1  
Year:
Make:
Model:
Vehicle ID#:
Vehicle #2  
Year:
Make:
Model:
Vehicle ID#
Vehicle #3  
Year:
Make:
Model:
Vehicle ID#

Driver Info:

 
Driver#1  
Name:
Date of Birth:
License#:
Vehicle Driven:
How many miles one way?
Do you have health insurance?
No
Tickets or accidents in last 3 years?
No
If yes, what kind and date of occurrence:
Driver#2  
Name:
Date of Birth:
License#:
Vehicle Driven:
How many miles one way?
Do you have health insurance?
No
Tickets or accidents in last 3 years?
No
If yes, what kind and date of occurrence:

Additional Information:

Member of any groups?:  
Senior
College Gradate
Credit Union
Professional (teacher, engineers, CPA, doctor)
Other  
Current Insurance Company?
Current Bodily liability limits?  
50/100
100/300
250/500
500/500
Other  

Deductible

Comprehension Deductible  
Vehicle 1 Vehicle2 Vehicle3
100 100 100
250 250 250
500 500 500
Other Other Other
Collision Deductible  
500
1000
Other
Board Form
Basic
 
Home Owner
No