1. ϖ MetLife Auto & Home ® Fact Finder ϖ
For no-obligation quotes, fax this form to your agent.
For accurate comparative quotes, include your current insurance policies “Declarations” pages in the fax:
Nate Powlison Fax: 1-866-302-5407 Phone: (503) 682-6283 Cell (503) 310-5407
Concerned about identity theft?
Our standard auto, homeowners, renters, and condo customers receive Identity Theft Resolution Service at no additional cost.*
Name_____________________________ SS#______________ Spouse/Civil Union Partner Name _______________ E-mail_________________________
Street Address_________________________________________ City____________________ State_______ Zip_________ County___________________
Home Phone_____________________ Work Phone_____________________ Cell Phone_____________________ Years at current address___________
I prefer to be contacted where/what time__________________________ Occupation_________________________ Full time or Part time ____________
Employer____________________________ Years with current employer_________ Payroll Frequency ____________ Employee ID _________________
Auto Insurance
Auto Policy Expiration Date_________________ Current Auto Insurance Company____________________________ Current Premium _____________
Policy #___________________ Years with Carrier _______ Who owns the vehicles? ________________________________________________________
Current Coverages (please circle) 25/50 50/100 100/300 250/500 Current Collision Deductible (please circle) 250 500 1000
DRIVERS IN
HOUSEHOLD
Marit Number
Date of Driver's License Gender al of Number
Name Birth Number M/F Status Tickets of Claims Age first Licensed
ALL VEHICLES IN
HOUSEHOLD
Where parked at home
Primary (garage, driveway, on Miles one way to Airbag Anti-Lock Alarm
Year Make Model Driver street, etc .) Work / School Locations Brakes Y/N Y/N
Homeowners Insurance
I want to insure a Home Condo or Townhome (please circle: Center or End Unit) Renters Other_______________________________
Homeowners Policy Expiration Date_____________ Current Insurance Company___________________________ Current Premium ________________
Policy #______________ Years with Carrier _____ Who owns the home? ___________ Current Dwelling Amt ___________ Market Value___________
Liability (please circle) 100K 300K 500K 1M Deductible (please circle) 250 500 1000 Do you Escrow? Y / N
Square Feet (above ground) ________________ Year Built ______ Number of Families _____ Do you have:
Style of Home ___________________________ Age of: Roof __________ dead bolts? Y / N
Exterior Type ___________________________ Age of: Electrical __________ fire extinguisher? Y / N
Number of baths: Full ________Half ________ Age of: Plumbing __________ smoke detectors? Y / N
Type of Heating ______________ Age of: Heating __________ central fire alarm? Y / N
Location of Oil Tank ____________ Miles to Fire Department __________ central burglar alarm? Y / N
Claim in the last 5 years ___________________ Number of Feet to Fire Hydrant __________ local burglar alarm? Y / N
Value of Contents (renters only) ____________ Number of Fireplaces _________________ trampoline? Y / N
Value of “special” property such as jewelry, fine art, or expensive computer equipment_________________ Any animals ? _______________

2. MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates: Metropolitan Casualty Insurance Company , Metropolitan Direct Property and Casualty Insurance Company, Metropolitan
General Insurance Company, Metropolitan Group Property and Casualty Insurance Company, and Metropolitan Lloyds Insurance Company of Texas, all with administrative home offices in Warwick, RI. Coverage, rates, and discounts
are available in most states to those who qualify. * Not available in all states. Not available to auto customers in NC or NH nor to home customers in NC.
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