insureU Colorado Quote Request-Beth

1
What type of insurance quote would you like?* This field is required.We recommend letting us quote both your home and auto for maximum savings.
Home and Auto
Home
Auto
2
Tell us about you!* This field is required.If married, your spouse's information will be required as well. Make sure to scroll down or sideways to see all fields.
3
More about you* This field is required.Why do we need to know this? Some carriers offer discounts for certain occupations or education.
4
Please provide your Driver's License information.* This field is required.Line 4d on the new Colorado driver's license.
5
Are you married or is there a co-applicant?
YESNO
6
Co-applicant's relationship to you.
Spouse
Fiance
Sibling
Parent
Domestic Partner
Partner
Friend
Other
7
Spouse/Co-applicant info* This field is required.
8
More about Spouse/Co-applicant* This field is required.Why do we need to know this? Some carriers offer discounts for certain occupations or education.
9
Spouse/Co-applicant Driver's License information.* This field is required.Line 4d on the new Colorado driver's license.
10
What is your current address?* This field is required.If you are purchasing a new home or moving we will be asking for that address in a moment!
Street Address
Unit/Apartment number
City
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
11
Phone Number:* This field is required.
12
Is it OK to text you if we need additional information?* This field is required.
YESNO
13
Email address:* This field is required.
example@example.com
14
Address to be insured* This field is required.What address would you like a quote for?
Street Address
Unit/Apartment number
City
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
15
Type of policy needed* This field is required.
Home Insurance
Town-home/Condo Insurance
Renter's Insurance
Secondary Home
Rental Property
Short Term Rental (Air B&B/VRBO)
16
What are you required to insure for your Town-home/Condo?
The interior only (studs in)
The entire structure (interior and exterior)
17
Who are you currently insured with for Home insurance?
Not Currently Insured
Allstate
American Family
Amica
ASI
Auto Owners
Country Financial
Encompass
Esurance
Farmers
Geico
General
MetLife
Nationwide
Progressive
Safeco
State Auto
State Farm
Travelers
USAA
Other
18
Is this home a New Build?* This field is required.Built within the current calendar year.
YESNO
19
Type of Home* This field is required.
Ranch (1 Story)
2 Story
3 Story
Bi Level
Tri Level
Duplex
Town-home/Condo
Other
20
Total Square Footage (do not include basement)* This field is required.
21
Primary Foundation Type:* This field is required.
Slab
Crawlspace
Basement-Below Ground
Basement- Walkout
Finished- Below Ground Basement
Finished- Walkout Basement
22
How many Bathrooms?* This field is required.
1
2
3
4
5+
23
How many Car Garage?* This field is required.
1
2
3
4
5+
24
How old is the roof on the home to be insured? (best guess)* This field is required.
25
Do you have any dogs?* This field is required.
YESNO
26
What Breed(s)? If "mixed" we HAVE to know what the mix is. * This field is required.Why? Some insurance companies don't allow certain dog breeds
27
Do you have a trampoline?* This field is required.
YESNO
28
Do you have a swimming pool?* This field is required.
YESNO
29
Do you have any home insurance claims in the last 5 Years?* This field is required.
YESNO
30
Please provide details.Example: Washing machine leak in 2019
31
Has the homes heating been updated within the last 35 years?* This field is required.
YESNO
32
Home insurance has limitations for certain valuable items such as Jewelry, Fine-art, Guns and Collectibles. Do you have valuable items we need to be aware of?
YESNO
33
Please list any items and values* This field is required.Example: Wedding Ring $10,000
34
Who are you currently insured with for auto insurance?* This field is required.Why? This helps us make sure we don't shop your current company.
Not Currently Insured
Allstate
American Family
Amica
ASI
Auto Owners
Country Financial
Encompass
Esurance
Farmers
Geico
General
MetLife
Nationwide
Progressive
Safeco
State Auto
State Farm
Travelers
USAA
Other
35
How much are you currently paying for auto insurance?This helps us know what we are trying to beat! If we cant beat it, we will tell you to stay put! Yeah weird, we know! We're not like the other guys!
Example: $185 per month
36
Are there any additional drivers in your household?* This field is required.
YESNO
37
Please list all additional drivers in the household.Leave blank if none.
38
Vehicle Information:* This field is required.Please provide information for all vehicles in the home. If multiple, please press "+ Click to add another vehicle".
39
Do any household drivers have a speeding ticket in the last 3 Years?* This field is required.
YESNO
40
Do any household drivers have an AT FAULT accident in the last 5 years?* This field is required.
YESNO
41
Are any vehicles used for Rideshare? i.e. Uber, Lyft, DoorDash* This field is required.
YESNO
42
Do you own or rent your home?* This field is required.
Own
Rent
43
Anything else we need to know?Do you have a boat, motorcycle or anything else we may not have asked about?
Huge
Large
Normal
Small
Ok
Ok
44
How did you hear about us?* This field is required.Please be detailed to make sure we know who sent you to us!
Do NOT simply put "lender" or "realtor". Thank you!
45
Estimated Household Annual incomeThis is important to help us make sure we are recommending proper liability limits to protect your assets and income.
Less than $50,000
$50,000-$100,000
$100,000-$150,000
$150,000-$250,000
$250,000+
46
Would you like us to provide an Umbrella Insurance quote?* This field is required.An umbrella policy is additional liability coverage that goes above and beyond your home and auto insurance limits. Please note, 250/500 liability limits are required on your auto policy to qualify for an umbrella.
YESNO
47
Would you like us to provide a Life Insurance quote to protect your Family/Mortgage if something were to happen to you?
YESNO
48
Insurance rates are determined using a combination of credit and claims history. By clicking “Next” I give insureU Colorado consent to run a soft credit inquiry* This field is required.
49
Before you hit "SUBMIT", please note the below delivery schedule. All delivery days are in "business days". May vary during holidays.
Should be Empty: