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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 homeowner's insurance quote. If you are looking for a quote on automobile insurance, please click here.
HOMEOWNERS INSURANCE QUOTE FORM

Customer Info:

Name:
Telephone:
Email Address: (Required)

Address:

City:
State:
Zip:
Age of Insured:
All members of household non-smokers?
No

Dwelling Info:

Year Built/Age of Home: /
Exterior Wall Construction:
No

Number of Stories:

Total Square Footage:
Substructure:
  If you selected Basement is it:
Amount of coverage:
If new purchase, amount of mortgage:
Replacement Cost:
Deductible
Liability:
Fireplace:
No
  If yes how many?
  If yes w/chimney?
No
Woodburner:
No
Air Conditioning:
No
If yes select one
Deck or porches:
  If yes what is the size?
Burglar or Fire Alarms?
No
  If yes select one
Baths
Smoke Alarms:
No
  If yes how many?
Fire Extinguishers:
No
  If yes how many?
Deadbolt Locks?
No

Additional Info:

Garage:
No
#Car:
Any other structures on property:
No
Amount of coverage:
Miles to Fire Department:
Fire Hydrants?
No
Distance from hydrant:

Is house visible by 5 other houses?

No
Swimming Pool?
No
  If yes is it
  And is it Fenced in
No
Trampoline?
No