Request a Quote

Pick an Insurance Type to Begin

Homeowners

Renters

Auto

Commercial Auto

Motorcycle

Term Life

Business

Notary Bond

Homeowners Insurance Quote

"*" indicates required fields

Step 1 of 5 - Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

MM slash DD slash YYYY

Driver's License Number*

Driver's License State*

State

Primary Phone Number*

Email*

Are there more household members?*

Yes

Name and birth date of all other household members*

Have you been continually insured for 6 months prior to the quote?*

Yes

New Purchase

Current Insurance Company*

Current Policy Expiration Date*

MM slash DD slash YYYY

Current Insurance Policy*

Max. file size: 300 MB.

We are looking for a PDF or picture of your current insurance policy showing the coverage page so we know what coverages you currently have.

View Example »

Closing Date*

MM slash DD slash YYYY

Mortgage Company*

Mortgage Company Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is this property primary or seasonal?

Primary

Seasonal

Township of Home:*

County*

Market Value of Home:*

Construction Type

Year home was built*

Year the Roof on the home was last updated:*

Year the Electrical in the home was last updated:*

Year the Plumbing in the home was last updated:*

Year the Heating in the home was last updated:*

Less than 1000 feet to a fire hydrant?

Name of responding Fire Dept:*

Miles to Fire Dept:*

Smoke Detectors?*

Yes

Fire Extinguishers?*

Yes

Non Smokers?*

Yes

Deadbolt Locks?*

Yes

Central Station Alarm:*

None

Police

Fire

Both

Does the home have a woodstove or supplement heating device?*

Yes, a woodstove

Yes, a Supplement Heating Device

Do you operate a business out of your home?*

Yes

Please Explain

Does the home have a trampoline ?*

Yes

Does is have a screen around it?

Does the home have a pool?*

Yes

Is it Above Ground or In Ground?*

Above Ground

In Ground

Is the pool fenced in?*

Yes

Does the pool have a diving board?*

Yes

Does the pool have a slide?*

Yes

Does the home have a hot tub?*

Yes

Does the hot tub have a locking top?

Yes

Do you own any dogs?*

Yes

How many?

More than 5

What breed are the dogs?

Do any of your dogs have a bite history?

Yes

Do you own any Horses*

Yes

How Many?

More than 3

Do you own any Recreational Vehicles?

Yes

Make

Type

Do you own a watercraft?

Yes

Make

Type

Schedule any items such as jewelry, furs or guns?*

Yes

Claims/Property Losses in Past 5 Years?*

Yes

Please explain

Date of Loss

MM slash DD slash YYYY

Amount Paid:

Additional Homes:

Are you a member of a credit union?*

Yes

Name

Alumni of a 4 year college?*

Yes

Name

Members of an association?*

Yes

Name

Are you a member of a civic organization?*

Yes

Name

Are you a member of AARP?*

Yes

How did you hear about us?

Search engine (Google, Bing, Yahoo, etc.)

Recommended by a friend or colleague

Social media

Blog or other publication

Other

Name of friend or colleague

Name

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Renters Insurance Quote

"*" indicates required fields

Step 1 of 3 - Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Alternate Phone

Email*

Date of Birth*

MM slash DD slash YYYY

Estimated Coverage Amount

Amount Requested on Contents

Do you currently have insurance?

Current Insurance Provider

Are you a member of a credit union?

Yes

Name

Alumni of a 4 year college?*

Yes

Name

Members of an association?*

Yes

Name

Members of a civic organization?*

Yes

Name

Members of AARP?*

Yes

How did you hear about us?

Search engine (Google, Bing, Yahoo, etc.)

Recommended by a friend or colleague

Social media

Blog or other publication

Other

Name of friend or colleague

Comments

This field is for validation purposes and should be left unchanged.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Auto Insurance Quote

"*" indicates required fields

Step 1 of 5 - Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Email*

Have you been continually insured for 6 months prior to the quote?*

Yes

Current Insurance Co.*

Current Policy Expiration Date*

MM slash DD slash YYYY

Current Insurance Policy*

Max. file size: 300 MB.

We are looking for a PDF or picture of your current insurance policy showing the coverage page so we know what coverages you currently have.

View Example »

Vehicle 1: Year, Make and Model*

Vehicle 1 Vin #*

Name of Driver for Vehicle 1

First Last

Date of Birth for Driver of Vehicle 1*

MM slash DD slash YYYY

Driver Licenses # for Driver of Vehicle 1*

Air Bags: Driver Side or Dual for Vehicle 1

Driver's Side

Dual

Anti Lock Brakes: for Vehicle 1

Yes

Anti - Theft Devices for Vehicle 1

Yes

Occupation*

Miles Driven to Work*

Social Security Number

Is there a lienholder on the car?

Yes

Name of lienholder*

First Last

Address of lienholder*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add 2nd vehicle?

Yes

Vehicle 2: Year, Make and Model*

Vehicle 2 Vin #*

Name of Driver of Vehicle 2

First Last

Date of Birth for Driver of Vehicle 2

MM slash DD slash YYYY

Driver Licenses # for Driver of Vehicle 2

Air Bags: Driver Side or Dual for Vehicle 2

Driver's Side

Dual

Anti - Theft Devices for Vehicle 2

Yes

Occupation*

Miles Driven to Work*

Social Security Number

Add 3rd Vehicle?

Yes

Vehicle 3: Year, Make and Model*

Vehicle 3 Vin #*

Name of Driver of Vehicle 3

First Last

Date of Birth for Driver of Vehicle 3

MM slash DD slash YYYY

Driver Licenses # for Driver of Vehicle 3

Air Bags: Driver Side or Dual for Vehicle 3

Driver's Side

Dual

Anti Lock Brakes: for Vehicle 3

Yes

Anti - Theft Devices for Vehicle 3

Yes

Occupation*

Miles Driven to Work*

Social Security Number

Add 4th Vehicle?

Yes

Vehicle 4: Year, Make and Model*

Vehicle 4 Vin #*

Name of Driver of Vehicle 4

First Last

Date of Birth of Driver of Vehicle 4

MM slash DD slash YYYY

Driver Licenses # of Driver of Vehicle 4

Anti Lock Brakes: for Vehicle 4

Yes

Anti - Theft Devices for Vehicle 4

Yes

Occupation*

Miles Driven to Work*

Social Security Number

Additional Vehicles

Accidents or Violations in the Past 5 Years?*

If yes, please explain

Claims/Property Losses in Past 5 Years?*

If yes, please explain

Consent to Run Insurance Score?*

Medical Carrier*

Covers Auto Injury?*

All ages of family members living at home*

Licensed Drivers in Household: Name & Date of Birth*

Additional Comments

Are you a member of a credit union?*

Yes

Name

Alumni of a 4 year college?*

Yes

Name

Members of an association?*

Yes

Name

Members of a civic organization?*

Yes

Name

Members of AARP?*

Yes

How did you hear about us?

Search engine (Google, Bing, Yahoo, etc.)

Recommended by a friend or colleague

Social media

Blog or other publication

Other

Name of friend or colleague

Phone

This field is for validation purposes and should be left unchanged.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Commercial Auto Insurance Quote

"*" indicates required fields

Step 1 of 6 - Personal Information

Company Name*

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Alternate Phone

Company Owner's Name

First Last

Vehicle Year*

Make*

Model*

VIN #

Current Value

License State*

State

License Number*

Do you currently have insurance?*

Yes

When did you last have insurance?

MM slash DD slash YYYY

Current Insurance Provider

Coverage

Liability Only

Comprehensive

Comprehensive & Collision

Injury Protection

2500

5000

10000

Comprehensive Deductible

250

500

1000

Collision Deductible

250

500

1000

Coverage Amount*

Rental

Yes

Towing

Yes

Number of Additional Insured Needed

How did you hear about us?

Are you a member of a credit union?*

Yes

Name

Alumni of a 4 year college?*

Yes

Name

Members of an association?*

Yes

Name

Members of a civic organization?*

Yes

Name

Members of AARP?*

Yes

How did you hear about us?

Search engine (Google, Bing, Yahoo, etc.)

Recommended by a friend or colleague

Social media

Blog or other publication

Other

Name of friend or colleague

This field is for validation purposes and should be left unchanged.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Motorcycle Insurance Quote

"*" indicates required fields

Step 1 of 4 - Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Alternate Phone

Email*

Have you been continually insured for 6 months prior to the quote?*

Yes

Current Insurance Co.*

Current Policy Expiration Date*

MM slash DD slash YYYY

Current Insurance Policy*

Max. file size: 300 MB.

We are looking for a PDF or picture of your current insurance policy showing the coverage page so we know what coverages you currently have.

Social Security Number

Date Of Birth*

MM slash DD slash YYYY

License Number*

License State*

State

Gender

Marital Status

Accidents or Violations? Please Explain

Year*

Make*

Model*

VIN #*

CC's*

Coverage

Comprehensive Deductible

Collision Deductible

Are you the only operator?

How many miles will you drive your motorcycle annually? (Approximately)

Do you currently have insurance?

Current Insurance Policy*

Max. file size: 300 MB.

When did you last have insurance?

MM slash DD slash YYYY

Are you a member of a credit union?*

Yes

Name

Alumni of a 4 year college?*

Yes

Name

Members of a civic organization?*

Yes

Name

Members of an association?*

Yes

Name

Members of AARP?*

Yes

How did you hear about us?

Search engine (Google, Bing, Yahoo, etc.)

Recommended by a friend or colleague

Social media

Blog or other publication

Other

Name of friend or colleague

Name

This field is for validation purposes and should be left unchanged.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Term Life Insurance Quote

"*" indicates required fields

Step 1 of 4 - Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Alternate Phone

Date of Birth*

MM slash DD slash YYYY

Height*

Weight

Gender*

Female

Male

Tobacco Used?

Yes

Coverage Amount*

Length of Coverage in Years*

Coverage Period

Premium Payment

How did you hear about us?

Are you a member of a credit union?*

Yes

Name

Alumni of a 4 year college?*

Yes

Name

Members of an association?*

Yes

Name

Members of a civic organization?*

Yes

Name

Members of AARP?*

Yes

How did you hear about us?

Search engine (Google, Bing, Yahoo, etc.)

Recommended by a friend or colleague

Social media

Blog or other publication

Other

Name of friend or colleague

Comments

This field is for validation purposes and should be left unchanged.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Business Insurance Quote

"*" indicates required fields

Step 1 of 10 - General Information

Applicant Name*

First Last

Business Name*

DBA (if applicable)

Mailing Address*

Street Address County City State ZIP Code

Phone*

Fax

Email*

Location Address*

Street Address County City State ZIP Code

Principal Contact Name*

First Last

Phone*

Email*

Legal Entity (Select One)*

Corporation

LLC

Partnership

Individual

Not For Profit

Other

Date Business Established*

FEIN*

SIC Code*

Years in Operation*

Years of Owner Experience in Industry*

Description of Operations*

Min. 10 words

Number of Full Time Employees*

Number of Part Time Employees*

Gross Annual Payroll*

Gross Annual Revenue*

Insurance Coverage Requested*

Select all that apply

Business Owners Policy (BOP)

General Liability

Professional Liability

Commercial Auto

Worker's Comp

Other

Is your business currently insured?

Yes

Current Insurance Carrier*

Current Policy Expiration Date*

MM slash DD slash YYYY

Current Policy Retroactive Date*

MM slash DD slash YYYY

Current Limits*

Desired Effective Date for New Policy*

MM slash DD slash YYYY

Desired Limits*

Desired Deductible:*

Are you requesting Property Coverage?*

Yes

Current Carrier*

If no current insurance, enter "NONE."

Location #1 Details

Is there a Boiler machinery Coverage Exposure?*

Yes

Is there Earthquake Sprinkler Leakage Exposure?*

Yes

Is there Underground Tank Leakage Exposure?*

Yes

Do employees handle cash?*

Yes

Building Ownership*

Owned

Triple Net Lease

Lease

Location #1 Address*

Street Address County City State ZIP Code

Building Information

Insured sq feet*

Occupied sq feet*

Unoccupied sq feet*

Total sq feet*

Describe other occupancies*

Construction Type

Number of Stories*

% Sprinklered*

Building within city limits

Yes

Year Built

Year Renovated

Mandatory if building is greater than 10 years old

Roof

Electrical

Plumbing

Heating/AC

Building Security

Fire Alarm*

None

Local

Central

Burglar Alarm*

None

Local

Central

Smoke Detectors*

None

Battery

Hardwired

Property Values

Building*

Personal Property*

Stock*

Business Income

Annual Gross Revenue*

Estimate Annual Payroll*

Add a second location?*

Yes

Location #2 Details

Is there a Boiler machinery Coverage Exposure?*

Yes

Is there Earthquake Sprinkler Leakage Exposure*

Yes

Is there Underground Tank Leakage Exposure*

Yes

Do employees handle cash*

Yes

Building Ownership*

Owned

Triple Net Lease

Lease

Location #2 Address*

Street Address County City State ZIP Code

Building Information

Insured sq feet

Occupied sq feet*

Unoccupied sq feet*

Total sq feet*

Describe other occupancies:

Construction Type*

Number of stories*

% Sprinklered*

Building within city limits*

Yes

Year Built*

Year Renovated

Mandatory if building is greater than 1 O years old

Roof

Electrical

Plumbing

Heating/AC

Building Security

Fire Alarm*

None

Local

Central

Burglar Alarm*

None

Local

Central

Smoke Detectors*

None

Battery

Hard Wired

Property Values

Building*

Personal Property*

Stock*

Business Income

Annual Gross Revenue*

Estimate Annual Payroll*

Add a third location?*

Yes

Location #3 Details

Is there Boiler Machinery Coverage Exposure*

Yes

Is there Earthquake Sprinkler Leakage Exposure*

Yes

Is there Underground Tank Leakage Exposure*

Yes

Do employees handle cash*

Yes

Building Ownership*

Owned

Triple Net Lease

Lease

Location #3 Address*

Street Address County City State ZIP Code

Building Information

Insured sq feet

Occupied sq feet

Unoccupied sq feet

Total sq feet

Describe other occupancies

Construction Type*

Number of stories*

% Sprinklered*

Building within city limits

Yes

Year Built

Year Renovated

Mandatory if building is greater than 10 years old

Roof

Electrical

Plumbing

Heating/AC

Building Security

Fire Alarm*

None

Local

Central

Burglar Alarm*

None

Local

Central

Smoke Detectors*

None

Battery

Hardwired

Property Values

Building*

Personal Property*

Stock*

Business Income

Annual Gross Revenue*

Estimate Annual Payroll*

Are you requesting General Liability Coverage?*

Yes

Current Carrier*

If no current insurance, enter "NONE."

Are Professional Services offered?*

Yes

Please describe the professional services offered*

Are any autos used exclusively for business use?*

Yes

Do any employees use a personal auto for business use?*

Yes

Are credit card payments accepted?*

Yes

Are any web based services offered?*

Yes

Is there a program to identify identity theft?*

Yes

Is there Underground Tank Leakage Exposure?*

Yes

Is there a Pollution Exposure?*

Yes

Are you requesting Professional Liability Coverage?*

Yes

Current Carrier*

If no current insurance, enter "NONE."

Desired Amount of Professional Liability Coverage*

Describe Professional Services offered*

Min. 10 words

Does your firm provide services outside the U.S.?*

Yes

Percentages of Services

US %*

Foreign %*

Does your firm use Independent Contractors (ICs) or Sub Contractors?*

Yes

Full Time*

Part Time*

Is there a formal Safety Plan?*

Yes

What is the percentage of your firm's gross Fees paid to ICs or Sub Contractors last year?*

Do you request Certificates of Insurance from ICs and Sub Contractors?*

Do you have written agreements on every project?*

Do ICs and Sub Contractors have written agreements?*

Do you provide Professional Liability to your ICs and Sub Contractors?*

Are you requesting Allied Medical Professional Liability Coverage?*

Yes

Current Carrier*

If no current insurance, enter "NONE."

Desired Amount of Professional Liability Coverage*

Describe Professional Services offered*

Does your firm use Independent Contractors (ICs) or Sub Contractors*

Yes

Full Time*

Part Time*

Do you employ Physicians or Surgeons?*

Yes

Is there a Medical Director?*

Yes

Does the Medical Director have their own insurance?*

Yes

Do you bill for Medicare/Medicaid?*

Yes

Do you request Certificates of Insurance from ICs and Sub Contractors?*

Yes

Do you have written agreements on every project?*

Yes

Do ICs and Sub Contractors have written agreements?*

Yes

Do you provide Professional Liability to your ICs and Sub Contractors?*

Yes

Are you requesting Workers' Compensation Coverage?*

Yes

Current Carrier*

If no current insurance, enter "NONE."

Number of Employees

Full Time*

Part Time*

Volunteer*

TOTAL*

Number of Independent Contractors (ICs):

Full Time*

Part Time*

Are Medical Benefits Offered?*

Yes

Do you offer Paid Vacation?*

Yes

Is there a formal Safety Program?*

Yes

Total Estimated Payroll*

Payroll Information

Class Code, Duties or Description*

# of FT Employees*

# of PT Employees*

Estimated Payroll*

Class Code, Duties or Description

# of FT Employees

# of PT Employees

Estimated Payroll

Class Code, Duties or Description

# of FT Employees

# of PT Employees

Estimated Payroll

Employees/Owners to Be Exlcuded

For the Payroll Information section above for all locations

Name

Title

Estimated Payroll

Name

Title

Estimated Payroll

Name

Title

Estimated Payroll

Name

Title

Estimated Payroll

Additional Coverage Interests

Select all that apply

Commercial Umbrella

Employment Practices Liability

Buy/Sell Agreement

Bonds

Crime/Employee Dishonesty

Medicare/Medicaid Billing E&O

Cyber Liability

Regulatory Shut Down

Directors and Officer Liability

Other

How did you hear about us?

Search engine (Google, Bing, Yahoo, etc.)

Recommended by a friend or colleague

Social media

Blog or other publication

Other

Name of friend or colleague

Name

This field is for validation purposes and should be left unchanged.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Notary Bond Quote

"*" indicates required fields

Full Legal Name*

First Middle Last

Date of Birth*

MM slash DD slash YYYY

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Email*

Amount*

Amount of $10,000 - Legally required by the state of Michigan*

Drivers License Number*

Have you ever been convicted of a felony or misdemeanor in the last 10 years?*

Yes

Have you ever held a notary public commission in Michigan?*

Yes

Have you ever held notary in any other state?*

Yes

In which state(s)?*

Have you ever had notary suspended, cancelled or revoked?*

Yes

In which state?*

Are you a licensed attorney in the state of Michigan?*

Yes

State Barn Number*

Any previous and/or alias names – example adopted, married and changed last name?*

Yes

Name

This field is for validation purposes and should be left unchanged.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Pick an Insurance Type to Begin

Homeowners

Renters

Auto

Commercial Auto

Motorcycle

Term Life

Business

Notary Bond

Homeowners Insurance Quote

Location #1 Details

Building Information

Year Renovated

Building Security

Property Values

Business Income

Location #2 Details

Building Information

Year Renovated

Building Security

Property Values

Business Income

Location #3 Details

Building Information

Year Renovated

Building Security

Property Values

Business Income

Number of Employees

Number of Independent Contractors (ICs):

Payroll Information

Employees/Owners to Be Exlcuded

Company

Linkfield & Cross Insurance Agency

DeVries of Caledonia Insurance Agency

Services

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