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Michael W. Smith Agency

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Homeowners

If you live outside of Minnesota click on the Agency Link System

For Homeowners, Condominium/Townhouse Owners & Renters Insurance Quotes, please complete the form below.

This is a request for a Minnesota homeowners quote, not a policy application. Submitting this form does not obligate you to purchase any homeowners or renters insurance products. Please complete this form as accurately as possible. Homeowner insurance rates are subject to change.

General Information

Name
Street
City, State ZIP
County Located
E-mail
Phone
Fax:
Send information by:

Current Insurance Information

Insurance Company	Expiration Date

Dwelling Information

Occupancy	Usage

Type	Construction

Property Coverage Information

Dwelling Amount	Contents	Other Structures

Deductible	Personal Liability	Medical Payments

Scheduled Property

Jewelry	$	Furs	$
Fine Art/Antiques	$	Guns	$
Silverware	$	Golf Equipment	$
Musical Instruments	$	Cameras	$
Computer Equipment	$	Stamps/Coins	$

Dwelling Protection

Responding Fire Department	Miles to Fire Department	Feet to Fire Hydrant

Fire Alarm	Fire Sprinkler System	Burglar Alarm

Applicant's Underwriting Information

Date of birth	Marital Status	Social Security Number

Current address if different from dwelling address

Underwriting Information

Year Built	Year Heating Updated	Year Wiring Updated

Year Roof Updated	Year Plumbing Updated	Woodstove
		Yes No
Swimming Pool	Claims Last 3 Years	What Happened & Amount Paid
Yes No	Yes No

Additional Comments

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Number of hits since August 15, 1998

Send mail to mwsmith@visi.com with questions or comments about this web site.

Since 1978
Michael W. Smith Agency