Personal Lines Intake Form

Auto Insurance Information Needed
Do You Own or Rent Your Primary Address?*

OwnRent
Are There Any Other Drivers Besides 1st and 2nd Named Insured?*

YesNo
State Other Drivers Name, Date of Birth, Plus Driver's License Numbers for all Household Occupants Who Have Access to Your Vehicle(s)
All household members over the age of 16 must be listed. If you don't want to insure them, type their name and say "excluded."
What Discounts Would You Be Interested In

PaperlessAutomatic PaymentsPay in Full (6 Month or 12 Month Options May Be Available)Telematics Program Participation
VIN Numbers for All Vehicles*
Can categorize as Vehicle 1, 2, 3 etc
State Which Vehicle is Owned, Financed, or Leased Along with the Institution which Finances or Leases the Vehicle*
Can categorize as Vehicle 1, 2, 3 etc
Upload A Copy of Your Current Policy Declarations Page

For rating purposes, we need to know how long you have been with your current insurance carrier, the bodily injury liability limits, and your expiration date. If you cannot find a copy of your current insurance policy (which is an issue in and of itself - we'll make sure you always have access to it with our agency's app!), please provide: length of time with carrier, prior bodily injury liability limits, and your expiration date in the Additional Details section. If you don't currently have coverage, state why in the Additional Details section.
Cancelof
Additional Details
Use this to describe anything you want us to know about your vehicles that didn't fit this form!

Address of the Rental Property*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Will the Property Be in the Name of an LLC*

YesNo
Choose the Type of Leases You Allow*

12 Month or Longer6-12 MonthsMonth to MonthHome-Sharing - i.e. Airbnb, VRBO, etc
Most Recent Updates/Installation
The Roof was replaced inYear*
The Electrical System was replaced inYear
The HVAC was replaced inYear
The Plumbing System was replaced inYear

*Put NA for Rental Condo Unit Policy Insurance Inquiries*
*If you aren't sure, please provide your best estimate or any details on its condition/updates in the Additional Details section below*
Will any Renovations be Done to the Property Which Will Require the Location to Be Vacant for More Than 90 Days?*

YesNo
Description of Planned Renovations
Include the following: if licensed and insured contractors will perform the work, a description of the work, the estimated cost of renovations, and timeline for the renovation to be completed
Additional Details
Use this to describe anything you want us to know about your rental property that didn't fit this form!

Would You Be Interested in a Free Life Insurance Quote?*

YesNo
Additional Details
We want to make sure we find you the coverage you want. Feel free to take this space to let us know what you are looking for in an insurance company. We will do our best to find it for you!
Should be Empty:

Personal Lines Intake Form

Property Insurance Information Needed

Auto Insurance Information Needed