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Bremen, IN
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Indianapolis, IN
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Home & Auto Insurance Proposal
Let's get started!
Insurance designed to meet your needs.
When it comes to insurance, you need more than just coverage. You need a trusted advisor. Our insurance advisors will custom-design an insurance program that is tailored to meet your specific needs.
Here to Help
888-345-3049
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Home & Auto Insurance Proposal
Step
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12
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General Information
Insured #1 Name
*
Insured #1 Date of Birth
*
MM slash DD slash YYYY
Insured #1 Occupation
*
Job title and field of work is perfect!
Insured #1 Social Security Number
Indiana, and many other states, allow insurance companies to factor one's credit score when deciding a premium. Don't worry though, this credit check is what is known as a "soft inquiry" and will not affect one's credit score. About half of the companies we represent require this information to move forward with a quote. Oh, and you should know our website is encrypted with bank-level secure sockets layer (SSL).
Email
*
Phone Number(s)
*
Desired Effective Date / Anticipated Home Closing Date
*
MM slash DD slash YYYY
Please use this field to enter the desired effective date of the policy. If purchasing a new home, this will be the anticipated closing date (don't worry, it's okay if this changes!).
Do you have a spouse, partner, children, or dependents that you'd like to include on the policy?
*
Yes
No
Spouse and/or Dependent Information
Insured #2 Name
*
Please enter your spouse, partner, or child's name.
Insured #2 Date of Birth
*
MM slash DD slash YYYY
Insured #2 Occupation
*
Job title and field of work is perfect!
Insured #2 Social Security Number
Insured #3 Name
Please enter your spouse, partner, or child's name.
Insured #3 Date of Birth
MM slash DD slash YYYY
Insured #4 Name
Please enter your spouse, partner, or child's name.
Insured #4 Date of Birth
MM slash DD slash YYYY
Insured #5 Name
Please enter your spouse, partner, or child's name.
Insured #5 Date of Birth
MM slash DD slash YYYY
Add any other dependents and their dates of birth here. You can also use this space for any special notes about your dependents.
Property (Home or Renters) Information
What is your current address?
*
Have you lived at your current address for three years or more?
*
Yes
No
What is your previous address?
*
Do you (or are you in the process of) own(ing) a home?
*
Yes
No
Renter's Insurance Underwriting Information
What is the total value of your personal property?
*
$10,000
$20,000
$30,000
$40,000
$50,000
If you were somehow able to pick your apartment up and shake it, what would be the total value of everything that would fall out (i.e. everything you own)?
What amount do you prefer for your renter's insurance deductible?
*
$250
$500
$1,000
$1,500
$2,000
The "deductible" is the amount of money you would want to "self-insure" for in the event of a loss. For example, let's say some of your personal belongings are stolen from your apartment, and the cost to replace the belongings is $5,000. If your deductible is $1,000, the insurance company will pay $4,000 ($5,000 loss - $1,000 deductible = $4,000 insurance pay out).
Do you own a dog(s) or an exotic pet(s) (snake, etc.)?
*
Yes
No
Dog Breed / Exotic Pet Type #1
Dog Breed / Exotic Pet Type #2
Dog Breed / Exotic Pet Type #3
If you have an additional dog(s) or exotic pet to add, please do so here. Also, if you have an exotic pet and feel additional information may be helpful, please include it here.
Are you hoping to bundle your auto insurance with your renter's insurance?
*
Yes
No
Most of our companies offer deep discounts when the home and auto insurance is packaged together!
Homeowner's Insurance Underwriting Information
These questions are used to underwrite your home. If you don't know an answer, it's okay to skip the question for now. Some of the questions may help determine coverage or provide a discount.
Is this a current home or future home purchase?
*
Current Home
Future Home
What is the address of your future home?
Do you (or will you) have a mortgage?
*
Yes
No
We ask this because some of our carriers give incredible discounts for homes that are fully paid off. This type of accomplishment deserves a big discount!
What type of home is this?
*
Single Family
Townhome/Condo
Duplex
Something Else
Please provide more detail about the home/structure you are puchasing.
When was the roof replaced?
The "year" is just fine.
When was the furnace last replaced?
Hidden
What type of electricity does the home use?
*
200-Amp (most common in homes with updated electric)
Circuit Breaker
Something Else
Not Sure
Has the electric system been replaced?
Yes
No
What year was the electric replaced?
Do you own a dog(s) or an exotic pet(s) (snake, etc.)?
*
Yes
No
Dog Breed / Exotic Pet Type #1
Dog Breed / Exotic Pet Type #2
Dog Breed / Exotic Pet Type #3
If you have an additional dog(s) or exotic pet to add, please do so here. Also, if you have an exotic pet and feel additional information may be helpful, please include it here.
Will this home be used for any home sharing service?
*
Yes
No
Airbnb, Vrbo, etc.
Does the home have a wood burning stove, trampoline, pool, or some other non-standard item that you think we should know about?
*
Yes
No
Exposure Identification
Wood Burning Stove
Pool
Trampoline
Do you have any personal property to schedule on the policy?
*
Yes
No
The standard homeowner's insurance policy puts sublimits (between $1,500-$2,500) on items like: jewelry, fur, and guns. Because of these sublimits, we often need to schedule these types of items to make sure they are covered.
Please share the items you'd like to have scheduled on the policy with their appraised value.
If you don't have this information handy, we can add it to the proposal after the initial quoting process.
What amount do you prefer for your homeowner's insurance deductible?
*
$1,000
$1,500
$2,000
$2,500
$5,000
The "deductible" is the amount of money you would want to "self-insure" for in the event of a loss. For example, let's say your home is damaged in a hail storm, and the cost to repair the damage is $5,000. Your deductible is $1,500. The insurance company will pay $3,500 ($5,000 loss - $1,500 deductible = $3,500 insurance pay out).
Are you hoping to bundle your auto insurance with your homeowner's insurance?
*
Yes
No
Most of our companies offer deep discounts when the home and auto insurance is packaged together!
Driver Information
Insured #1 Driver's License Number
*
Will there be other drivers on the policy?
*
Yes
No
Insured #2 Driver's License Number
*
Insured #3 Driver's License Number
Insured #4 Driver's License Number
Insured #5 Driver's License Number
Add the driver's license numbers for any remaining drivers and any special notes here.
Vehicle Information
Vehicle #1: Year, Make, Model, and VIN (if available)
Will there be other vehicles on the policy?
*
Yes
No
Vehicle #2: Year, Make, Model, and VIN (if available)
Vehicle #3: Year, Make, Model, and VIN (if available)
Vehicle #4: Year, Make, Model, and VIN (if available)
Vehicle #5: Year, Make, Model, and VIN (if available)
Are any vehicles used for ride sharing or renting?
Yes
No
Uber, Lyft, Turo, etc.
Do any vehicles have after market customization that increases the value of the vehicle by more than $1,500?
Yes
No
Please share the vehicle(s), type of equipment added, and estimated cost of each piece of equipment.
Add the vehicle information for any remaining vehicles and any special notes here.
What amount do you prefer for your auto insurance deductible?
*
$100
$250
$500
$1,000
$2,000
Discount Questions
The answers to these questions are all related to special discounts with the companies we represent!
Insured #1's Profession and Title
Insured #1's Highest Level of Education
High School Diploma
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
Doctoral Degree
Insured #2's Profession and Title
Insured #2's Highest Level of Education
High School Diploma
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
Doctoral Degree
Is an insured on your policy a student in high school or college?
Yes
No
What is their current cumulative grade point average?
Has the student taken a certified driver's education course and attained a certificate of completion for the course?
Yes
No
Do you have any "toys" to add to the policy?
*
Yes
No
A "toy" may include a boat, personal watercraft, all terrain vehicle (ATV), snow mobile, etc.
Toy #1: Year, Make, Model, and VIN or Serial #
Toy #2: Year, Make, Model, and VIN or Serial #
Toy #3: Year, Make, Model, and VIN or Serial #
Add the pertinent information for any remaining toys and any special notes here.
Current Insurance Information
Two things that set our agency apart are: 1. As an "independent" agency we represent multiple carriers which allows us to find you the best combination of coverage and price. 2. We offer coverage and premium comparisons against your current insurance carrier for no additional cost.
Do you want to share your current insurance information?
*
Yes, I'll upload my current declarations pages.
Yes, I'll input my current policy limits.
No, thank you!
Auto Insurance Bodily Injury Liability Limit
$25,000 per person / $50,000 per accident
$50,000 per person / $100,000 per accident
$100,000 per person / $300,000 per accident
$250,000 per person / $500,000 per accident
$500,000 Combined Single Limit (CSL)
$1,000,000 Combined Single Limit (CSL)
Auto Insurance Property Damage Liability Limit
$25,000 (state minimum)
$50,000
$100,000
$250,000
Homeowner's Insurance Personal Liability Limit
$100,000
$300,000
$500,000
$1,000,000
Current Declarations Pages
Drop files here or
Select files
Max. file size: 300 MB.
Please upload your current auto and homeowner's insurance information here. Feel free to add anything you wish to share and we can sort through what we'll need to put together a concise comparison.
Anything Else We Should Know?
Is there anything else you think it is important for us to know about your specific situation? If yes, use this space to tell us about it.
What's Next?
The BEST client experience for YOU is incredibly important to us. This section will help us meet your specific expectations. We want to become your insurance "guy" or "gal".
Is there a specific MIG team member you've been referred to who can help make this happen?
*
If no preference, that's fine too!
How quickly do you expect to get your proposal?
*
By the end of the day
Within 24 hours
Within 48 hours
By the end of the week
A few weeks before my policy effective date
Moving forward, in which way do you prefer to communicate about your proposal?
*
Email
Telephone
No Preference
Saying "Thank you!" to the clients who refer us to other great people, is important to us. So, who referred you?
*
If you didn't hear about us through a referral, let us know how you found your way here!
Thank you!
Hey, great work! We appreciate the time you took to input the information we need to create an accurate proposal. Now we'll get to work for you. You'll hear from a Miller Insurance Group team member shortly. Thank you and have a great day!
This field is for validation purposes and should be left unchanged.
This field is for validation purposes and should be left unchanged.
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Close Menu
About
The MIG Difference
We’re Independent
Meet the Team
Insurance Partners
The Keystone Partnership
Testimonials
Careers
Services
Business
Personal
Benefits
Specialty
Resources
Clickable Coverage
FAQs
Client Portal
Pay Insurance Bill
Refer a Friend
Report a Claim
Request Auto ID Card
Request Certificate
Blog
Locations
Bremen, IN
Culver, IN
Wakarusa, IN
Indianapolis, IN
Get Proposal
Visit Bremen, IN Insurance | Indianapolis, IN Insurance - Miller Insurance Group on Facebook