Online Home Owners Quote From Huizenga & Wierenga Insurance Agency

Huizenga & Wierenga Insurance Agency is happy to provide online quote service, please be advised that online quotes are sent through email not a secured server. No information to be provided to Huizenga and Wierenga Insurance Agency is mandatory to fill in, if you are not comfortable giving any type of information through our internet quote service please contact us personally to provide us with the remaining information needed to complete you quote.

Applicant's Name
Applicant's Email
Applicant's Work Phone
Applicant's Home Phone
Applicant's Cell Phone
Applicant's Occupation
Time Employed With Company
Applicant's Address
Applicant's City
Applicant's State
Applicant's Zipcode
Applicant's County
Years Lived At Address
Current Insured Company Name
Current Annual Premium
Expiration Date of Policy
Type of Policy	Primary Secondary
Desired Deductible	$100 $200 $500
Amount of Liability	$100,000 $200,000 $500,000 $1,000,000
Estimated Replacement Cost
Year Constructed
Number of Levels	1 Story 1.5 Story 2 Story Bi-Level Tri-Level Other
Type of Construction	Wood Stucco Mansonry Brick Veneer Aluminum Siding Other
Other Home Features	Dead Bolts Smoke Detectors Fire Extinuisher Central Fire Alarm Central Burglar Alarm Located within 5 mile of Fire Station Located with 1000 feet of Fire Hydrant Swimming Pool Trampoline Located within City Limits
Date of Last Claim
Amount Paid
Claim Type
Description of Last Claim
Date of Last Claim
Amount Paid
Claim Type
Description of Last Claim
Date of Last Claim
Amount Paid
Claim Type
Description of Claim
$ Amount of Jewelry/Watches
$ Amount of Furs
$ Amount of Silver
$ Amount of Firearms
$ Amount of Coin/Stamp Collections
$ Amount of Fine Arts/Breakables
Any Additional Comments