Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Valid Phone number required. Note that we will never call you, but some insurers may.
Format: (000) 000-0000.
Back
Next
Save
Property Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Back
Next
Save
Your DOB
*
 -
Month
 -
Day
Year
Date
Number of Residents
*
Field accepts only whole numbers
Spouse (if applicable)
First Name
Last Name
Spouse DOB
 -
Month
 -
Day
Year
Date
Back
Next
Save
Check the boxes for all the quotes you want.
*
Home
Auto
Umbrella
Back
Next
Save
Home Coverage Details
Info we need to get an insurance quote. The easiest way is to submit a copy/picture of your current policy. If upload doesn't work, email us your docs at quotehelp@informedinsurance.com.
Upload Your Current Home Policy Coverage Page(s) (pdf, docx, jpg, png)
*
Manual Entry Option:
I'm unable to upload the coverage page(s) and need to enter the information manually
Your Current Carrier
*
Please Select Carrier
Allstate
State Farm
Progressive
Farmers
Liberty
Chubb
USAA
Travelers
American Family
Other
If your insurer is not listed, enter name to the right
Other Carrier
Current Premium
*
Annual premium, estimate ok
Property/Dwelling Insured Value
*
Coverage Type
*
Extended
Guaranteed Replacement
I don't know
Other Structures Coverage
*
Liability Coverage
*
Personal Property Coverage
*
Medical Payments Coverage
Loss of Use/Additional Living
*
Other Coverages Type & Amounts
Deductible
*
Wind/Hail/Hurricane Deductible
Back
Next
Save
Auto Coverage Details
Info we need in order to request quotes for bundled coverage. If upload doesn't work, email us your docs at quotehelp@informedinsurance.com.
Upload Your Current Auto Policy Coverage Page(s) (pdf, docx, jpg, png)
*
Manual Entry Option:
I'm unable to upload the coverage page(s) and need to enter the information manually
Name, Gender, Age of all drivers
*
Policy Information
Total Current 6-month Premium (All Vehicles)
*
Estimate ok, enter half if annual premium
Bodily Injury Limit
*
Property Damage Limit
*
Uninsured Motorist Bodily Injury Limit
Leave blank if none
Uninsured Motorist Prop. Damage Limit
Leave blank if none
Personal Injury Protection Limit
Leave blank if none
Medical Benefits Limit
Leave blank if none
Vehicle Information
Number of Vehicles
*
Please Select
1
2
3
4
Vehicle 1: VIN or Year/Make/Model
*
We need either VIN or Year/Make/Model to rate for BI coverage.
Collision Deductible
Leave blank if none
Comprehensive Deductible
Leave blank if none
Loss of Use/Rental Car Coverage
Leave blank if none
Other Coverages
Leave blank if none
Vehicle 2: VIN or Year/Make/Model
*
We need either VIN or Year/Make/Model to rate for BI coverage.
Collision Deductible
Leave blank if none
Comprehensive Deductible
Leave blank if none
Loss of Use/Rental Car Coverage
Leave blank if none
Other Coverages
Leave blank if none
Vehicle 3: VIN or Year/Make/Model
*
We need either VIN or Year/Make/Model to rate for BI coverage.
Collision Deductible
Leave blank if none
Comprehensive Deductible
Leave blank if none
Loss of Use/Rental Car Coverage
Leave blank if none
Other Coverages
Leave blank if none
Vehicle 4: VIN or Year/Make/Model
*
We need either VIN or Year/Make/Model to rate for BI coverage.
Collision Deductible
Leave blank if none
Comprehensive Deductible
Leave blank if none
Loss of Use/Rental Car Coverage
Leave blank if none
Other Coverages
Leave blank if none
Back
Next
Save
Umbrella Coverage Details
Info we need to get quotes for bundled coverage. If upload doesn't work, email us your docs at quotehelp@informedinsurance.com.
Upload Your Current Umbrella Policy Coverage Page(s) (pdf, docx, jpg, png)
*
Manual Entry Option:
I need to enter the information manually (no coverage page or no current policy)
Limit sought
*
Current Premium
*
Estimate ok
Names of all persons covered
*
We will send you a request for additional info, if and when necessary
Back
Next
Save
For More Precise Quotes and Optimized Value
We can provide more accurate quotes if you provide some additional information
What is the approximate age of your roof? (estimate ok, leave blank if unknown)
What's your roofing material?
*
Please Select
Asphalt Shingle
Metal
Plastic Shingle
Shale
Solar Shingle
Tar/Gravel/Rubber
Concrete Tile
Wood Shingle
Don't Know
Are you willing to pay either upfront or through escrow to receive a discount?
*
Yes, upfront
Yes, through escrow
No
What is the highest deductible you would be comfortable with?
Please Select
$1,000
$2,500
$5,000
$10,000
>$10,000
Are there any risks you are particularly concerned about that require extra attention?
Would you like us to prioritize quotes by lowest price, most coverage, or best combo?
*
Lowest Price
Most Coverage
Best Combination
Anything else we should know, or do you have any questions we should consider?
Back
Next
Save
Assumptions
Please review the following assumptions we make about you and change any that are inaccurate.
Have you had a claim in the last 5 years?
*
No
Yes
Date of the Claim
Estimate ok
Type of Event
Is this home your primary residence
*
Yes
No
How many days a year are you there?
Estimate ok
Do you rent part or all of your home
*
No
Yes
Please provide details
Long term v. short term rental, whole/partial?.
Is your home used for business?
*
No
Yes
Nature of the business
Do you have any pets considered potentially dangerous or with a biting history?
*
No
Yes
Type of pet. If dog, identify breed
Do you have a trampoline
*
No
Yes
Do you have a wood-burning stove?
*
No
Yes
By checking this box, you agree that you take full responsibility for your purchase decision, should one occur based on any of the resulting quotes.
*
I agree.
Save
Submit Request
Should be Empty: