Thaddeus Tuttle Agency Auto Insurance Quote Form

AUTO INSURANCE QUOTE FORM

You can fill out this form to save time on the phone with an agent. To apply for an auto insurance quote please complete the questions you can. If you do not know the answer you may leave it blank. An agent will get back to you within 24 hours to review. Entry form is voluntary. Enter as much data as desired. If any data is unknown, leave blank.
Discount Capture Questions
Do You Own An RV, Travel Trailer, Golf Cart, ATV/UTV, Side By Side, Boat, Motorcycle, Other Trailer, or Classic Auto?
Do you currently have life insurance?
Are you active or retired military?
Would you like to sign documents by E-Signature? Selecting "Yes" provides a discount.
Would you like paperless policy and billing? Selecting "Yes" provides a discount.
Have you taken a Senior Defensive Driver's Course within the past 3 years? You will receive a discount if you have.
What date would you like your policy to begin? Selecting 7 days out will provide a discount.
example: 5/5/2026
What is your occupation?
Name*

First NameLast Name
Birth Date*

MonthDayYear
E-mail
example@example.com
Phone Number*
Garaging Address - where you park your car*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mailing Address - If different from above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender?*
Spouse's Name

First NameLast Name
Spouse's Date of birth

MonthDayYear

Who is your existing auto insurance company?
example: Progressive Auto Insurance
Have you had continuous auto insurance for the past 6 months?*

YesNo
Please list all drivers in the Household with a valid drivers license and their Date of Birth*
example: John Doe 1/1/2002
List the year, make and model of the vehicle(s) you would like us to quote.
Anything else you would want the agent to know regarding the auto insurance?
Upload auto insurance document, ID and related documents

Cancelof
Referral (If we are able to connect and quote the referral, we will send you a $10 gift card)

First NameLast Name
Phone Number*
E-mail
example@example.com

IF YOU WOULD LIKE TO BUNDLE HOME OR RENTERS, PLEASE CONTINUE
Property Address - IF DIFFERENT FROM ABOVE

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this also the mailing address?
Occupancy Type
Is there any unrepaired damage to the dwelling?
example: Unrepaired damage could be missing siding, missing shingles, missing facia or soffits, peeling or chipping paint, broken/boarded up windows, ect.
Pool?
Pool area gated or fenced in?
Is there a trampoline on the property?
Is the yard fenced?
Separate structures on the property are properly maintained and all repairs have been completed?
Is there a business on property?
Are there any dogs that have bit someone kept at the residence?
If yes, we have an endorsement for this.
Is the dwelling a mobile home, trailer or manufactured home?
Is your insurance payment escrowed through a lender?
If Yes to escrow, what is your lenders name, address and your loan number?
Year Built
Square Feet
Plumbing Type
If it's a mix, select which plumbing type is the majority.
Have you completed a full (not partial) update(s) to Electrical, Plumbing, or HVAC?
If yes, please enter what kind of update and the updated year.
In order to get a discount, the update must have been a full update with documentation to verify.
Age of Roof
Are you within 5 miles of a fire department?
Do you have any central theft, fire or water protection devices in the home?
Number of stories?
Roof Shingle Type
Foundation Type
What type of siding?
Garage (# of Cars)
Is the garage attached to the home or detached?
Floor types
Percentage of each flooring type?
Heating System
Cooling System
Do you have a dedicated dining room?
Number of Baths
Number of Bedrooms
Claims in last 5 years?
Patio Sq. Ft.
Put 0 if no patio
Porch Sq. Ft.
Put 0 if no porch
Deck Sq. Ft.
Put 0 if no deck
All perils deductible amount
Split wind/hail deductible amount
This deductible is only for claims made due to wind and hail only.
What would you value your separate structures/outbuilding at?
What limit would you like your personal/premise liability set at?
Do you have a sump pump?
Should be Empty:

AUTO INSURANCE QUOTE FORM

Discount Capture Questions

IF YOU WOULD LIKE TO BUNDLE HOME OR RENTERS, PLEASE CONTINUE