Home Owners Insurance Quote

Want a quote for Home Owners Insurance? Fill out this form as completely as possible.
Fields with "*" are required. Click "Send to Lenz" when you are finished.
We'll respond by the next business day. Thank you!
About You
Your Name*
Your Email Address*
Your Birthdate*
Your Phone Number*
Current Address*
City*
State*
Zip Code*
Previous Address (If less than 3 years
at Current Address)
Your Employer
Your Job Position
Co-insured's Name
Co-insured's Birthdate
Co-insured's Phone Number
Co-insured's Employer
Co-insured's Job Position
List Any Credit Unions or Groups/Associations that you are a member of:

About Your Home and Insurance Coverage
Location Address
(If different than above)
Do You Currently Have Home Owners Insurance? Yes   No  
If Yes, With Whom?
If Yes, Policy Expiration Date
Home in What County?  
Is Home Inside City Limits? Yes   No
If Yes, What City?
If No, What Township?
Primary Fire Department?  
How Far? (miles)
Nearest Fire Hydrant? (feet)
Date Purchased
Mortgage? Yes   No
Dwelling Coverage ($)
Approximate Square Feet
Basement? Yes   No
Deductible ($)
Outbuilding(s)
Year Built
System Updates, if any Electrical, Year Updated
Plumbing, Year Updated
Heating, Year Updated
Roof, Year Updated
Construction Frame  Brick  Log
Mobile  Modular
Check "Yes" If Any Apply: Wood Stove, Indoor Yes
Wood Stove, Outdoor Yes
Deadbolts Yes
Swimming Pool
(in ground or above ground)		 Yes
Trampoline Yes
Fire Extinguishers Yes
Day Care Provider Yes
Smoke Alarms Yes
Gas or Wood Fireplace Yes
Security Alarm
(fire, burglar, local, central)		 Yes
Located in a Subdivision? Yes   No
Home Can Be Seen By At Least Two Other Houses? Yes   No
Pets or Farm Animals On Property? Yes   No
If Yes, What Kind?
Any Bite History? Yes  No
Any Losses in the Last Three Years? Yes   No
If Yes, Please Describe:
Any Scheduled Items? Yes   No
If Yes, Please List:

How Should We Communicate With You
and Provide Your Quote?
Please email me
Please telephone me



Thank you!
Please feel free to contact us with questions or for a quote anytime.

Ludington, 231-845-6279
Zeeland, 616-748-9440
Muskegon, 231-739-6300