1233 N Mayfair Rd # 104, Milwaukee, WI
Phone: (414) 453-6181 – Fax: (414) 453-0080 –
agents@macgillisandcompany.com
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Homeowners Insurance
Contact Information
Name:
Phone Number:
Email:
Preferred Method of Contact:
Select...
Email
Phone
Preferred Time of Day to Call:
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Morning
Evenings
Weekends
Question/Comment:
Homeowners Quote Information
Dwelling Amount:
Personal Property Limit (for renters quote):
Personal Liability Limit:
Select...
100,000
300,000
500,000
Medical:
Select...
1,000
2,500
5,000
Deductible:
Select...
500
1,000
2,500
5,000
Year Built:
Exterior:
Select...
Brick
Frame
Stone
Stucco
Wood
Square Footage:
How Old is Roof:
How Old is Furnace:
Finished Basement:
Select...
Yes
No
(if so what percentage):
Water Backup Sewer / Drains:
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5,000
10,000
25,000
50,000
Trampoline on Premises:
Select...
Yes
No
Any Scheduled Personal Property:
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Yes
No
Jewelry & Watches (Value):
Furs (Value):
Firearms (Value):
Fine Arts (Value):
Silver (Value):
Swimming Pool:
Select...
Yes
No
Any Claims In Past 5 Years?
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Yes
No
(if so brief description):
New Purchase?
Select...
Yes
No
Approximate Closing Date:
Currently Insured?
Select...
Yes
No
If so with whom:
Personal Umbrella Quote Requested?
Select...
Yes
No
Limit Requested:
Select...
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
Anti-Spam Question:
(Required)
Is water wet or dry?
