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Home > Homeowners > Homeowners Quote
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Homeowners Quote


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information
First Name *
Last Name *
Street *
City *
State *
ZIP / Postal Code *
E-Mail Address *
Primary Phone Number *
Alternate Phone Number
Date of Birth *
/ /
Current Information
Number of Household Members *
Do you currently have insurance?
Current Premium
Current Insurance Provider
Months With Company
Current Policy End Date
/ /
Liability Limit
Deductible Amount *
Dwelling Information
Address of Home (if different than above)
City, State. ZIP Code
Year Built
Construction Type
Date of Original Purchase
/ /
Square Footage *
Estimated Value *
Number of Full Bathrooms
Number of half bathrooms
Type of Garage *
Basement Finish
Percent of Basement Finished
Fireplace
Central Air
Smoke Detectors
Fire Extinghishers
Dead Bolt Locks
Dogs *
Smoking Allowed in Home
Pool *
Updates
Roof Update (MM/YYYY)
Electrical Update (MM/YYYY)
Plumbing Update (MM/YYYY)
HVAC Update (MM/YYYY)
Claims
Claims/Property Losses in Past 5 Years (Please Explain)
How did you hear about us?
Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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33039 Schoolcraft Road | Livonia, MI 48150
P: 313.255.9350 | F: 313.255.2068 | info@gbkinsurance.com
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