HOME POLICY | PLANNERS INSURANCE GROUP

PLANNERS INSURANCE GROUP | HOME POLICY INFORMATION

Please fill out the questions below to provide you an accurate quote.
Contact Information

Please put your full name and contact information below:
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Insured's Information

Please input all the required information below so that we can provide you more accurate quote.
Address of Property to be Insured *

Primary Address

Prior Address if less than 3 Years. If none, skip.

CityState / Province

Postal / Zip Code
Is your mailing address the same as your property address?*
Mailing Address*
Prior Address if less than 3 Years
Education*
Occupation*
Driver's License
State
Birth Date*

MonthDayYear
Marital Status*
Spouse's Information

Please input the information of your Spouse.
Name

Spouse's First NameSpouse's Last Name
Driver's License
Spouse's Driver's License
State
Spouse's Driver's License's State
Spouse's Birth date

MonthDayYear
Phone Number
Spouse's phone number.
Email
Spouse's email. example@example.com
Education
Spouse's Education
Occupation
Spouse's Occupation

Policy Information
Current Insurance*
How long is the insurance lapsed?*
What Carrier?*
Current Carrier*
For how long in Current Carrier?*
Please put the number of years or months you've been in that carrier. Example: 2 years; 6 months.
Expiration of Policy*

MonthDayYear
What is your expected closing date?*

MonthDayYear
Preferred Payment Plan*
Price you are currently paying
Mortgage Information
If you have a mortgage, please input your Mortgage Information here.
Coverage A*
Personal Liability*
Medical Payment*
Wind/Hail Deductible*
Example: 1%, 2%, $5,000
AOP Deductible*
Example: 1%, 2%, $5,000
Protection Class
Home Declaration Page

Do you have a soft copy of your Home Declaration Page? Upload it here.
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More about Homeowners

Please note anything about your Home.
Is there anything about your home that stands out or is unique that we did not ask?

BUNDLE YOUR HOME AND AUTO

One of the main benefits of bundling is that companies often offer discounts if you hold several policies with them, so it can save you money. In fact, most carriers will automatically add a multiple-policy discount on both policies, allowing you to save money on your total cost of insurance.
Do you want to bundle your home and auto?*

Auto Policy Information
Do you have a Prior Policy?*
State the Reason*
Current Carrier*
For how long in Current Carrier?*
Please put the number of years or months you've been in that carrier. Example: 2 years; 6 months.
Expiration of Policy*

MonthDayYear
Preferred Payment Plan*
Who are your additional Listed Drivers

If you have additional drivers, please put their Driver's License information below:
How many additional drivers do you have?*

EXCLUDED DRIVERS
Excluded Drivers

If you have excluded drivers, please put the reason below:
Full name | DOB| Driver's License - State | Reason
Example: John Smith, Jan 1, 1999, 12345678 TX, has own car insurance.

Vehicle Information

Please be sure to double check everything before you go next page.
Classic Car
Do you have a Classic Car?*
Please input Year Make & model | VIN Number | and Preferred Coverages:*
Example: Ferrari 250 GTO 1962, 123456ABCDEF, 30/60/25
Classic Car Declaration Page

Do you have a soft copy of your Classic Car Declaration Page? Upload it here.
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Personal Auto
How many Vehicles do you want to be Insured? *

More about Auto

Please note anything about your Auto
Is there anything you would like us to know about your vehicles or driving experience?
Please check everything if all details are accurate.
Should be Empty:

PLANNERS INSURANCE GROUP | HOME POLICY INFORMATION