Grubbs - United Insurance Service, Inc. -- Life Insurance Quote Request Form

Home Insurance Quote Request

*Required

If you would like a quote to compare with your current policy you're welcome to submit your information securely online and we'll get back to you within one business day or you can call us direct during business hours toll-free at (888) 201-8865.

First, tell us a bit about yourself:

*Name
*Address
*City & MI Zipcode
*Date of Birth
Social Security #	(?)

Now tell us a bit about your residence?
*Where do you live?
If you own a home, please complete the following:
Approximate age of your home?
What is the exterior construction of your home?		Other
What is the replacement value of your home?
What is your deductible preference?
What amount of liability coverage do you want?
Are there any smokers in your household?		YES NO
Do you have a woodburning stove in your home?		YES NO
Do you have a swimming pool?		YES NO
If yes, is the swimming pool enclosed by a fence?		YES NO
Do you have a trampoline?		YES NO
Do you have a central station reporting alarm system?		YES NO
On your current policy do you have any extra coverage for specific items like jewelry?		YES NO
If yes, please provide a brief description and value for these items.


If you live in a condo, please complete the following:
Approximate age of your condo?
What is the exterior construction of your condo?		Other
What amount of coverage do you need for your personal items?
What is your deductible preference?
While the condo association maintains coverage for the exterior of your building your bylaws may assign responsibility for covering parts of the dwelling on your own policy. Our condo policies include $25,000 of coverage for the building. If you need more than this amount please specify the amount of coverage needed here:
What amount of liability coverage do you want?
Are there any smokers in your household?		YES NO
Do you have a central station reporting alarm system?		YES NO
On your current policy do you have any extra coverage for specific items like jewelry?		YES NO
If yes, please provide a brief description and value for these items.


If you live in an apartment, please complete the following:
Approximate age of your apartment building?
What is the exterior construction of your building?		Other
What amount of coverage do you need for your personal items?
What is your deductible preference?
What amount of liability coverage do you want?
Are there any smokers in your household?		YES NO
Do you have a central station reporting alarm system?		YES NO
On your current policy do you have any extra coverage for specific items like jewelry?		YES NO
If yes, please provide a brief description and value for these items.


How did you hear about us?		First Name: Last: Description of Other:
Enter Promotion Code:
How do we get in contact with you?		INFO:

If you would like a quote with a multi-policy discount click below and your home quote will be submitted and you'll be taken to a separate screen with many of the answers already completed to submit the information on your vehicle… Or click below if you only want a home policy comparison right now…