Renters Insurance Quotes

Celebrating over 150 continuous years of service to
Marshall Michigan, and the State of Michigan

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   Mobile Home

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Personal Coverage

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Inland Marine (Valuable Property)

On-Line Renters Insurance Quote Form One Simple Form - takes only 2-3 Minutes! Your Personal Data:

Your Name:
Property Address:
City:
State:	Michigan!
Zip Code:
E-Mail (REQUIRED):
E-Mail (again for accuracy):
Phone:
Fax (optional):

Dwelling Information

Year Dwelling Built:
Home Square footage:

# Units in bldg.:
Square Footage in Apt:

Number of stories:	One Two Three 4+

Do you own animals or pets?	Yes No
If yes, list type/for dogs, list breed:	:

# of feet to nearest fire hydrant:	# of miles to nearest fire station:

Currently Insured?	Yes No
Name of Carrier & how long insured?

How is Your Credit History?	(Some Carriers use credit to qualify)

Prior Claims?	Yes No
Describe claims in detail:

Do you have a business on premises?	YesNO

# Fireplaces: # Chimneys:

Is there a woodstoveYesNO

Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)

Coverage's:

Contents $ Loss of Use $

Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)

Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):

Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone

Thank you for filling out this form COMPLETELY!
We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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Sullivan Insurance Agency, Inc.
140 W. Michigan Ave.
Marshall, MI 49068
Phone: 269-781-8909
Fax: 269-781-3535