Heidi Kussurelis Insurance Agency: Ann Arbor and Canton, MI
 
Ann Arbor
Canton
2405 S. Main St.
5918 N. Lilley Rd
Ann Arbor, MI 48103
Suite 1
866.613.6736
734.213.6736
Canton, MI 48187
734.927.3730
 
Home
About Us
Referral Program
Get a Quote
Contact Us

 
Get a Quote

For a professional phone consultation with a licensed, trained member of our team please provide as much information as you can below.

Just your name and phone number is enough, but the more details you provide, the more effective our time on the phone will be.

Click the banner above to purchase a policy.
*indicates required field
First Name*
Last Name*
Street Address
 Apartment Number
City
 State
 Township
 Zip
E-Mail Address*
 Phone Number*

About Your Home...

Home Insurance
Tenant Insurance
Condo Insurance
This is a quote for:
House Condo Renter
Home construction:
Frame Brick
Your current Dwelling Limit is $ (Homeowners Only)
Your current Property Limit is $
The amount of liability you would like for your Home:
$100,000 $300,000 $500,000
Year Built
Square Footage
The current deductible for your Home:
$250 $500 $1,000 $2,500
Do you have a home security system?
Yes No
Do you have any jewelry or collectibles to be scheduled?
Yes No
The current insurance carrier for your Home:
The current insurance premium for your Home:
Homeowner 1
Name
Date of Birth
MM DD YYYY
Social Security Number
Homeowner 2
Name
Date of Birth
MM DD YYYY
Social Security Number
Comments:
 

About Your Vehicles...

Auto Insurance Motorcycle Insurance Boat Insurance RV Insurance ATV Insurance Commercial Insurance
Are you currently insured?
Yes No
Vehicle 1
Year
VIN
Make
Model
Vehicle 2
Year
VIN
Make
Model
Vehicle 3
Year
VIN
Make
Model
Vehicle 4
Year
VIN
Make
Model
Your Current Comprehensive Deductible is:
$100 $250 $500 $1,000 Coverage Not Wanted
Your Current Collison Deductible is:
$100 $250 $500 $1,000 Coverage Not Wanted
Your Current Bodily Injury Limit (in thousands) is:
20/40 50/100 100/300 250/500 300/300 500/500
Your Current Uninsured Motorist Bodily Injury Limit (in thousands) is:
20/40 50/100 100/300 250/500 300/300 500/500
The current insurance carrier for your Autos:
The current insurance premium for your Autos:

Select any of the following you are interested in:

Towing
Rental Car
Customization
(any conversion or customized equipment)
Comments:

About the Drivers...
Driver 1
Name
Date of Birth
MM DD YYYY
Drivers License #:
Social Security Number
Driver 2
Name
Date of Birth
MM DD YYYY
Drivers License #:
Social Security Number
Driver 3
Name
Date of Birth
MM DD YYYY
Drivers License #:
Social Security Number
Driver 4
Name
Date of Birth
MM DD YYYY
Drivers License #:
Social Security Number
Comments:

 

 


Home | About Us | Referral Rewards | Get a Quote | Contact Us

© 2008, Heidi Kussurelis Agency and Scorching Web Design