Christopher P Shipley Insurance Agent
We are your "Broker's Insurance Agency."
Please Quote Insurance For:
*
Auto
Home
Mobile Home
Flood
Motorcycle
Business Insurance
Life Insurance
RV, Travel Trailer, Camper
ATV, SideBySide
Other
Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Cell Phone Number
*
Please enter a valid phone number.
Permission To Text?
*
Yes, Text About My Quotes
No, Do Not Text About My Quotes
Date Of Birth
*
Drivers License Number
*
State Issued
*
Automobile Quote Information
Scroll Past This Section If You Are Not Quoting Auto Coverage
AUTO QUOTES ONLY - Vehicle Identification Number (VIN) Auto #1
AUTO QUOTES ONLY - Vehicle Identification Number (VIN) Auto #2
AUTO QUOTES ONLY - Vehicle Identification Number (VIN) Auto #3
AUTO QUOTES ONLY - Is There A Lienholder On The Vehicle?
Yes
No
AUTO QUOTES ONLY - Please Quote The Following Coverage(s):
Cheapest Coverage Possible: $10,000 Property Damage / Personal Injury Protection Maximum of $10,000 (Also known as "Tag Insurance") NOT RECOMMENDED!
All Required State Minimum Limits: Bodily Injury $10,000 Per Person $20,000 Maximum Per Accident / Property Damage $10,000/ Personal Injury Protection Maximum $10,000
State Minimums and Coverage On Vehicle: Bodily Injury $10,000 Per Person $20,000 Maximum Per Accident / Property Damage $10,000/ Personal Injury Protection Maximum $10,000 / Comprehensive Coverage / Collision Coverage
Minimum "Full Coverage": Bodily Injury $10,000 Per Person $20,000 Maximum Per Accident / Property Damage $10,000/ Personal Injury Protection Maximum $10,000 / Comprehensive Coverage / Collision Coverage / Towing / Rental Car / Uninsured Motorist $10,000 Per Person $20,000 Maximum Per Accident
Modest "Full Coverage": Bodily Injury $25,000 Per Person $50,000 Maximum Per Accident / Property Damage $25,000/ Personal Injury Protection Maximum $10,000 / Comprehensive Coverage / Collision Coverage / Towing / Rental Car / Uninsured Motorist $25,000 Per Person $50,000 Per Accident
Advanced "Full Coverage": Bodily Injury $100,000 Per Person $300,000 Maximum Per Accident / Property Damage $100,000/ Personal Injury Protection Maximum $10,000 / Comprehensive Coverage / Collision Coverage / Towing / Rental Car / Uninsured Motorist $100,000 Per Person $300,000 Per Accident
I am not sure which coverages I need. Please call me before quoting.
Other - See Below
AUTO QUOTES ONLY - Other (From Above) - Please Quote These Coverages Only
AUTO QUOTES ONLY - Additional Information
Home Insurance Quote Information
Scroll Past This Section If You Are Not Quoting Homeowners Coverage
HOME INSURANCE QUOTE ONLY - Type Of Home Insurance Needed?
Rental Dwelling Coverage - I do not live in the home but I own the home
Homeowners Coverage - I live in the home and I own the home (either: permanent or seasonal)
HOME INSURANCE QUOTE ONLY - If Address Of Home Is Different From Above, List Address Of Home Here
HOME INSURANCE QUOTE ONLY - Is There a Mortgage On The Home?
Yes
No
HOME INSURANCE QUOTE ONLY - Is Your Home Currently Insured?
Yes
No
HOME INSURANCE QUOTE ONLY - Last Year Roof Was Replaced?
HOME INSURANCE QUOTE ONLY - What Was The Last Year You Had A Claim On Your Home? If So, What Was The Reason? If None, Type "NONE" If No Claims
Mobile Home Insurance Quote Information
Scroll Past This Section If You Are Not Quoting Mobile Home Information
MOBILE HOME INSURANCE QUOTE ONLY - Type Of Mobile Home Insurance Needed?
Rental Mobile Home Dwelling Coverage - I do not live in the mobile home but I own the mobile home
Mobile Homeowners Coverage - I live in the mobile home and I own the mobile home (either: permanent or seasonal)
MOBILE HOME INSURANCE QUOTE ONLY - If Address Of Mobile Home Is Different From Above, List Address Of Mobile Home Here
MOBILE HOME INSURANCE QUOTE ONLY - Is There a Mortgage On The Mobile Home?
Yes
No
MOBILE HOME INSURANCE QUOTE ONLY - Is Your Mobile Home Currently Insured?
Yes
No
MOBILE HOME INSURANCE QUOTE ONLY - Last Year Roof Was Replaced?
MOBILE HOME INSURANCE QUOTE ONLY - What Was The Last Year You Had A Claim On Your Home? If So, What Was The Reason? If None, Type "NONE" If No Claims
MOBILE HOME INSURANCE QUOTE ONLY - Length Of Mobile Home
MOBILE HOME INSURANCE QUOTE ONLY - Width Of Mobile Home
MOBILE HOME INSURANCE QUOTE ONLY - Year Mobile Home Was Manufactured
Flood Insurance Quote Information
Scroll Past This Section If You Are Not Quoting Flood Insurance
FLOOD INSURANCE QUOTE ONLY - Is There a Mortgage On The Home?
Yes
No
FLOOD INSURANCE QUOTE ONLY - What Was The Last Year You Had A Claim On Your Home? If So, What Was The Reason? If None, Type "NONE" If No Claims
Motorcycle Insurance Quote Information
Scroll Past This Section If You Do Not Need A Motorcycle Insurance Quote
MOTORCYCLE QUOTES ONLY - Vehicle Identification Number (VIN)
MOTORCYCLE QUOTES ONLY - Is There A Lienholder On The Vehicle?
Yes
No
Business Insurance Quote Information
Scroll Past This Section If You Do Not Need A Business Insurance Quote
BUSINESS INSURANCE ONLY - Name Of Business
BUSINESS INSURANCE ONLY - Type Of Legal Entity?
Sole Proprietor
Limited Liability Company
S Corporation
C Corporation
BUSINESS INSURANCE ONLY - Type Of Business (Example: Plumbing, Restaurant, Lawn Care, Mechanic's Garage, Auto Towing, etc.)
BUSINESS INSURANCE ONLY - Year Business Started?
BUSINESS INSURANCE ONLY - Expected Revenue This Year?
BUSINESS INSURANCE ONLY - Type of Coverages Needed?
Business Liability Only
Business Property (Building) Insurance
Business Vehicle Coverage
Business Equipement
Business Inventory
Business Workers Comp
Other - See Below
BUSINESS INSURANCE ONLY - Other From Above - Describe Coverage Needed
Life Insurance Quote Information
Scroll Past This Section If You Do Not Need A Life Insurance Quote
LIFE INSURANCE ONLY - Type Of Insurance Desired?
Final Expense Whole Life
Term Insurance
LIFE INSURANCE ONLY - Amount Of Coverage Desired?
Examples: Final Expense Whole Life $5,000, $10,000, $25,000 or Term Insurance $100,000, $250,000, $500,000, Etc.
RV, Travel Trailer, Camper, ATV, SideBySide
Scroll Past This Section If You Do Not Need An Insurance Quote For These Items
RV, TRAVEL TRAILER, CAMPER, ATV, SIDEBYSIDE ONLY - Identification Number (VIN)
RV, TRAVEL TRAILER, CAMPER, ATV, SIDEBYSIDE ONLY - Is There A Lienholder?
Yes
No
RV, TRAVEL TRAILER, CAMPER, ATV, SIDEBYSIDE ONLY - What Was The Purchase Price Of The Item?
Other Insurance Quote Requested
Scroll Past This Section If You Do Not Want Other Insurance Quotes
OTHER INSURANCE QUOTE REQUESTED - Describe The Type Of Coverage You Would Life To Request A Quote For, Amount Of Coverage Desired And Any Information That You Believe Will Assist Us In Providing You A Quote For This Coverage
Request My Quote
I or an individual acting on my behalf, request a quote based on the information provided in this form. I or an individual acting on my behalf, understand that no insurance is bound by completing this form to request a quote. I, or an individual acting on my behalf, further understand that Christohpher P Shipley Insurance Agent, associates and other affiliated parties will search multiple insurance companies, brokerages and agencies in an attempt to find me the lowest possible price, and will continue to retain my information for this purpose and will contact me by phone call, text (if approved above) and/or email with said quotes or to gather additional information for the quotes if needed. I or an individual acting on my behalf, understand that these quotes are only provided for individuals and/or companies that are domiciled in the State of Florida.
*
I or an individual acting on my behalf, approve and agree with the above terms
Referring Agent ID
Submit
Should be Empty: