Zeigler Insurance All purpose Quote Form

  • Zeigler Insurance Quote Form

  • Explain what makes us different from other Agencies:

    • Broker vs. Direct/Captive Agencies
    • Client FOCUSED Agency
    • Referral only agency... We want to do business we know like and trust just like you.
  • I want quotes on:
  • Are you Married?
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    • Auto Info: 
    • Currently Insured: Yes/No
    • Current Policy Expiration Date
       / /
    • Driver #1: Date of Birth
       / /
    • Driver #2: Date of Birth
       / /
    • Driver #3: Date of Birth
       - -
    • Driver #4: Date of Birth
       / /
    • Vehicle #1 Coverage Options: Select all that apply
    • Vehicle #1: Comprehensive Deductible Option:
    • Vehicle #1: Collision Deductible Option:
    • Vehicle #2 Coverage Options: Select all that apply
    • Vehicle #2: Comprehensive Deductible Option:
    • Vehicle #2: Collision Deductible Option:
    • Vehicle #3 Coverage Options: Select all that apply
    • Vehicle #3: Comprehensive Deductible Option:
    • Vehicle #3: Collision Deductible Option:
    • Vehicle #4 Coverage Options: Select all that apply
    • Vehicle #4: Comprehensive Deductible Option:
    • Vehicle #4: Collision Deductible Option:

    • Telematics: We have some companies offering telematics programs that monitors/tracks your mileage and driving habits through a mobile app that you download. i.e. speed, daily mileage, distracted driving (texting), hard breaking, fast acceleration, etc)  

      Companies are offering a 5% - 10% discount for the first policy term (6 months or 1 yr) just for signing up, then at renewal, you can qualify for an additional 10-20 discount based on the data/info they collected.

    • Telematics: Would you be interested in seeing what the discounted pricing would be if you signed up for a telematics program?
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    • Home Info: 
    • Is this for a new home purchase/closing?
    • Closing Date?
       - -
    • Currently Insured?
    • Current Policy Expiration Date
       - -
    • Central Air:
    • CB or Fuse
    • Fireplace:
    • Basement: Yes/No
    • Walkout: Yes/No
    • Garage: Attached/Detached
    • Swimming Pool:
    • Trampoline:
    •  
    • Umbrella 
    • Umbrella : Include UM / UIM
    •  
    • REC VEHICLE / TOY 
    • TYPE: (Select All That Apply)
    • Boat #1: Do you want insurance on boat trailer?
    • Boat #1 Coverage Options: Select all that apply
    • Boat #1: Comprehensive Deductible Option:
    • Boat #1: Collision Deductible Option:
    • Boat #2: Do you want insurance on boat trailer?
    • Boat #2 Coverage Options: Select all that apply
    • Boat #2: Comprehensive Deductible Option:
    • Boat #2: Collision Deductible Option:
    • Motorcycle/Moped #1 Coverage Options: Select all that apply
    • Motorcycle/Moped #1: Comprehensive Deductible Option:
    • Motorcycle/Moped #1: Collision Deductible Option:
    • Motorcycle/Moped #2 Coverage Options: Select all that apply
    • Motorcycle/Moped #2: Comprehensive Deductible Option:
    • Motorcycle/Moped #2: Collision Deductible Option:
    • Snowmobile #1 Coverage Options: Select all that apply
    • Snowmobile #1: Comprehensive Deductible Option:
    • Snowmobile #1: Collision Deductible Option:
    • Snowmobile #2 Coverage Options: Select all that apply
    • Snowmobile #2: Comprehensive Deductible Option:
    • Snowmobile #2: Collision Deductible Option:
    • ATV / UTV / GOLF CART #1 Coverage Options: Select all that apply
    • ATV / UTV / GOLF CART #1: Comprehensive Deductible Option:
    • ATV / UTV / GOLF CART #1: Collision Deductible Option:
    • ATV / UTV / GOLF CART #2 Coverage Options: Select all that apply
    • ATV / UTV / GOLF CART #2: Comprehensive Deductible Option:
    • ATV / UTV / GOLF CART #2: Collision Deductible Option:
    • CAMPER / TRAILER Coverage Options: Select all that apply
    • CAMPER / TRAILER: Comprehensive Deductible Option:
    • CAMPER / TRAILER: Collision Deductible Option:
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    • Should be Empty: