PROPERTY PROTECTION CLASS INQUIRY General Information

PROPERTY PROTECTION CLASS INQUIRY General Information

Date ______________________________________________ Policy/Quote No.________________________ Insured/Customer Name _________________________________ Location Address ________________________________________________________________________________ City __________________________________ State _____________________ Zip Code ________________ Phone No.___________________ County __________________ Cross Streets ________________________

Protection Class Information

Disputed Protection Class ________________ Disputed Fire Protection Area _____________________________ Requested Protection Class_______________ Road Miles to Responding Fire Department __________________ Requested Fire Protection Area or District_____________________________________________________________ Feet from Hydrant_______________________ Fire District Phone No. ___________________________________ Name/Title of Fire District Representative _____________________________________________________________ Responding Fire Department Name _________________________________________________________________ Responding Fire Department Address ________________________________________________________________

Problem Description

(Please explain in specific detail; forward any related documentation you may have - fire chief letters, etc.)

Agent Information

Agent Name ____________________________________________________________________________________ Agent Phone No. ________________________________________________________________________________ Agent E-mail____________________________________________________________________________________

Please complete all fields and fax to 616-956-3806 Attention: PPC Inquiry Team

Foremost Insurance Company Grand Rapids, Michigan, Foremost Property and Casualty Insurance Company, Foremost Signature Insurance Company, Foremost County Mutual Insurance Company, Foremost Lloyd's of Texas and American Federation Insurance Company, 5600 Beech Tree Lane, Caledonia, MI 49316.

Form 732189 06/09

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