Information not on your Declarations Pages

Named Insureds (owners of the policy or policies). If you're married, we have to list your spouse.*

Who has the best credit in the household? (Adults only, may get you a larger discount)*
How many people live in your home?
Everyone, not just drivers
New Driver or other driver changeNew vehicleMoving or other address changeGetting marriedOtherNone of the above
Other than rate, is there another reason you're shopping your insurance?*
AutoHomeUmbrellaRentersLifeHealthOther
How did you hear of us?
Which agent were you referred to or wanting to work with? If not referred to us and any agent in our office will work, please type "any".*
YesNo
What date do you need this by?

MonthDayYear
Date
What is the reason for the urgent request?
Please provide your current policies here or email them to service@edenins.com.

Browse Files

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Drivers (include everyone that lives with you that currently or has had a license, or regularly uses any of your vehicles):*

Rows	Driver Name	Date of Birth	Driver's License Number	Education Level	Occupation (use "student" for full time students)	Gender as it is listed on your Driver's License	Marital Status
Driver 1
Driver 2
Driver 3
Driver 4
Driver 5
Driver 6

Yes, all drivers are willing to do thisYes, only some drivers are willing to do thisDepends on the discountNo
Which drivers are willing to do the tracking?*
Which drivers (if any) qualify for the good student discount? (under 25, full time student, and at least a B average)

Vehicles*

Vehicles continued*

NoYes
If yes, what do you pull or haul with that vehicle?
Want any of these optional coverages:*
OEM PartsAccident or Ticket forgivenessDisappearing deductibleGuaranteed Replacement for brand new vehiclesNone of the aboveOther
How long have you been with your current insurance company for auto insurance?*
How long have you had continuous auto insurance without a gap between policies?*
YesNo
What date to you want to use? For the best rates, we suggest at least 2 weeks from today.*

MonthDayYear
Date
Pay in full (usually the largest discount)Monthly Automatic Payments from Checking or Savings (Usually the 2nd best rate)Monthly Recurring Credit CardMonthly Non-AutomaticOther
Any notes on the auto section

YesNo
What % of the basement is finished?*
How many full bathrooms do you have?*
How many half bathrooms do you have? *
Pool - Above GroundPool - In GroundTrampoline with nettingTrampoline without nettingDogNone of the above
Do you have a:*
If you have a dog(s), what is their name(s), breed(s) and age(s)?
YesNo

Dogs*

Rows	Name	Age	Spayed/ Neutered	Breed (if mixed, please list known breeds, as we can't use "mixed")	Any Bite History?
Dog 1
Dog 2
Dog 3
Dog 4

YesNo
What (if any) smart home devices do you have? (Please put "none" if you don't have any)*
NoYes, with no backup systemYes, with a backup system
NoYes

Year of Updates: (if unsure, put in your most reasonable guess, if still original to the house, put in the year the house was built)*

Rows	Roof	Plumbing	Electrical	Heating	Cooling	Water Heater
Year of Update:

Are there any current issues with any building on your property, or issues on the property? This is extremely important, so please review the entire list.*
YesNoNot Applicable
Please let us know which issues you would be able to fix ASAP and which you would not. *
Do you run a business out of your home? If so, please describe it.*
Guaranteed Replacement for the homeAll Risk Coverage for your Personal PropertyService Line CoverageEquipment Breakdown CoverageEarthquakeWater BackupNone of the above
Do you want any of the following optional coverages if you don't already carry them?*
How long have you been with your current company?*
If you've had any claims in the last 5 years, please provide date(s) and description(s). If no claims, enter "none"*
From my escrow accountI pay in full for the yearI pay monthlyOther
Any notes on the home section

Number of apartments in your building*
NoYes, only in the hallwaysYes, only in the apartmentsYes, in the hallways and the apartments
PoolsTrampolinesDogsNone of the above
If you don't currently have renters, how much would it cost to replace all your personal property?*
Any notes on the renters section

Who all are you wanting to cover?*

Who are you wanting coverage for?*

Do you have a specific plan, deductible, or co-pay in mind for your plan?*
To see if you qualify for a subsidy through the Affordable Care Act, what is the household annual income?
Any notes on the health section

Umbrella policies provide more liability coverage should you run out of coverage on your underlying policies. For example, you have a car accident where you are at fault and you're covered. Their medical bills, physical rehab bills, prescriptions, missed time from work, etc all add up to $850,000. You auto policy pays up to the policy limit, let say $250,000. With an umbrella, that policy would cover the other $600,000. Without an umbrella, they would come after you for reimbursement. It can vary by State what they are able to come after, but usually they can garnish your wages, take any money you have in savings, take tax returns, and can force you to sell extras (extra car, boat, motorcycle, ATV, 2nd home, etc.). For this reason, we recommend you at least have more coverage than you have in total assets, while also factoring in your income level to protect that too.
How much coverage would you like a quote for? *

Rows	Date	Who was this for?	Description of the incident	Cost if known (for claims/accidents)
Incident 1
Incident 2
Incident 3
Incident 4
Incident 5