Upper Peninsula Insurance Agency

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Quick Quotes

Please fill out the form below to contact us

Name:
Phone:
Email:
Date of Birth:
Marital Status:
Occupation:
Employer:
Years at current address:
Current Mailing Address:
Location Address:
County:
Currently Insured:
Current Insurance Company:
House Type:
Year Built:
# of Stories (not including basement):
Square Footage (not including basement):
Type of Siding:
Type of Roofing:
% Basement:
% Crawl Space:
% Slab:
% Finish Basement:
Walkout:
Deck Square Footage:
Porch square footage:
Open or Enclosed:
Central Air:
Garage:
Attached or Detached:
# of Cars:
Finished Area:
Any other outbuildings:
If yes, description & value:
Primary Heat Source:
Woodstove:
Fireplace:
Wood or Gas Insert:
# of Full Baths:
# of 1/2 Baths:
# of 3/4 Baths:
Pool:
If Yes, Above ground or In ground:
Fenced:
Age of Furance:
Age of Plumbing:
Age of Roof:
Age of Siding:
Age of Wiring:
Breakers or Fuses:
# of Amps:
Dwelling limit on current policy:
Personal Liability:
Medical Payments:
Deductible:
Primary Home:
If No, Seasonal or Secondary:
Non-Smoker:
Responding Fire Dept:
Miles to Fire Dept:
Fire Hydrant within 1000 feet:
Farming or livestock on premise:
If yes, describe:
Any business conducted on premise:
If yes, describe:
List # of dogs and breed:
Trampoline:
Please list any additional items to be scheduled on the policy (ex: Boats, ATVs, Snowmobiles, Jewelry, Collectibles):