Karcher Agency Inc.
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Choose the type of quote you would like to request using the list below. If you want us to quote multiple types of insurance, please contact us at 313.277.4600.
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Personal Information
Name
*
First
Last
Email Address
*
Physical Address
Street Address
City
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Alaska
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Delaware
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Texas
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mailing Address (if different from Physical Address)
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Work Phone
Social Security Number
*
Many of the companies we represent require this information prior to quoting.
Occupation
Employer Name
Name Insured's and their Birthdates
Insurance
Homeowners
Renters
Have you had continuous coverage for at least 12 months?
Yes
No
If not, why not?
Present Insurance Co.
Current Market Value
Present Coverage Amount
Renewal Date
Claims in Last 5 Years
0
1
2
3
4+
Date, Description and Amount Paid
List any Pets and their kind/breed
Deductible
500
1000
2500
5000
Premises Liability
300,000
500,000
1,000,000
Construction
Square Footage of Living Space
Year Home Was Built
House Type
1-Story
1 1/2-Story
2-Story
Split Level
Bi-Level
Tri-Level
Quad-Level
Construction
Frame or Stucco
Masonry Veneer
Masonry
Vinyl Sided
Aluminum Sided
Foundation
Basement
Crawl Space
Slab
Roof
Asphalt Shingle
Wood Shingle
Tile or Slate
Year Updated
Roof
Heating and Cooling
Plumbing
Electrical Year
Circuit Break Year
Fuse Box Year
Features
Garage
1-Car
2-Car
3-Car
4-Car
Attached
Detached
Basement
Built-In
Car Port
# of Full Bathrooms
1
2
3
4
5
# of Half Bathrooms
1
2
3
4
5
Other Features
Central Air Conditioning
Deck
Security System
Central Vacuum
Pool
Credits
Smoke Alarm
Fire Extinguisher
Dead Bolt
Nonsmoker
Central Station Alarm
Premises Alarm
# of Fireplace Chimneys
1
2
3
# of Fireplace Hearths
1
2
3
Is Basement Finished?
Yes
No
Basement Finished Sq. Ft
Sump Pump?
Yes
No
Deck Sq. Ft
Open Porch Sq. Ft
Screened Patio Sq. Ft
Enclosed Porch Sq. Ft
Comments
Name
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