Let's get an auto insurance quote!
Instructions
We will need to collect 3 types of information: Information about WHO we are insuring (ie. YOU), information about WHAT we are insuring (ie. your vehicles), and information about HOW MUCH insurance you would like to purchase. Please fill out the information below so that we can put together a customized proposal for you. You might wonder why we are asking some of this information- but we are searching for DISCOUNTS! Everyone loves discounts!!
How did you learn about us?
Customer Name (Insured 1)
*
First Name
Last Name
Birthday
*
-
Month
-
Day
Year
Date
Gender at birth
*
Female
Male
Current Marital Status
*
Single
Married
Divorced and not remarried
Widowed
What is your driver's license number?
*
Did you get your driver's license in the last 5 years?
*
Yes
No
What month/year did you get your driver's license?
What is your phone number?
*
Please enter a valid phone number.
What is a good email address for you?
example@example.com
Current address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you moved in the past 3 years?
*
Yes
No
What was your most previous address?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you:
*
Own and live in a single-family home
Own and live in a condo
Rent an apartment, duplex, or home
Live with someone
Something else
Customer Name (Insured 2)
*
First Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Gender at birth
Female
Male
What is your driver's license number? (Customer 2)
*
Did you get your driver's license in the last 5 years? (Customer 2)
*
Yes
No
What month/year did you get your driver's license (Customer 2)?
Does anyone else live in your home have their driver's license?
*
Yes and I need to add them to this policy
Yes but they have their own insurance
No, there are other people in the home, but they do not have their driver's license
No, there are not any other people in the home
How many additional drivers do you need to add?
1
2
3
More than 3
Driver's Name
*
First Name
Last Name
Birthday (Driver 1)
-
Month
-
Day
Year
Date
Gender at birth
Female
Male
Driver 1 Driver's License Number
Did you get your driver's license in the last 5 years? (Driver 1)
Yes
No
What month/year did you get your driver's license (Driver 1)?
Driver's Name (Driver 2)
First Name
Last Name
Birthday (Driver 2)
-
Month
-
Day
Year
Date
Gender at birth (Driver 2)
Female
Male
Driver 2 Driver's License Number
If Driver 2 has gotten his/her driver's license in the last 5 years, what month/year did you get your driver's license??
Driver's Name (Driver 3)
First Name
Last Name
Birthday (Driver 3)
-
Month
-
Day
Year
Date
Gender at birth (Driver 3)
Female
Male
Driver 3 Driver's License Number
If Driver 3 has gotten his/her driver's license in the last 5 years, what month/year did you get your driver's license?
Is / does anyone in the family:
*
Active military or a veteran?
A first responder?
Work in an emergency room?
Have a Masters degree?
Have a PhD or equivalent?
None of the above
Which of the following applies to you/your family?
*
We have a company car
Someone drivers for a rideshare company (ie. Uber/Lyft/other)
We have a classic car
We use the mobile app
We have AAA or another kind of roadside assistance
None of these
Back
Next
Now tell me about your vehicles!
How many vehicles will we be insuring?
*
One
Two
Three
More than three (we will send you an email with a bigger spreadsheet!)
Do you have any pop-up campers, travel trailers, horse trailers, or anything that you tow (excluding things like boats, etc) that you also need to insure?
*
Yes
No
Please tell me about the vehicles.
Vehicle 1
Vehicle 2
Vehicle 3
VIN
Year
Make
Model
Submodel/Trim
Owned/Leased/Payments
Who mostly drives this?
Back
Next
Insurance coverage time!
How protected do you want to be on your worst day?
Are you able to send us a copy of your current insurance so we can start with an "Apples to Apples" quote?
*
Yes- I can upload it here
Yes- I can email it to you at info@richardsgroupinsurance.com
Yes- but I am not sure how to do that. Can I take screen shots and text it to you?
No, I am not able to send you my insurance information
I do not have current insurance.
You can use this upload tool to upload your documents to us.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you like to pay for your insurance
*
Every 6 months (in full- so you get the "pay in full" discount
Monthly so I can spread it out over time
What payment method do you prefer when paying?
*
Automatic draft (EFT) from your checking account (*there is a discount for this)
Recurring payment on my credit card
Nothing automatic- I like to get a bill and either pay it online or mail a check
How do you prefer to GET your insurance documents?
*
Online / email (*there is a discount for this)
I prefer to get paper copies mailed to me
I currently:
*
Bundle my insurance with renters/condo/homeowners insurance. I am going to need to quote for that.
I don't bundle right now, but I would be open to the possibility if it is a good deal.
I don't have property insurance, but I also have some "toys" (motorcycle, boats, RV's, etc)
I rent but do not "own" my own renter's insurance policy. I may/may not be listed on my room-mates.
I rent but do not have any renter's insurance.
I live with someone but do not have a lease or pay rent, so I do not have renter's insurance.
None of these really fit my situation.
Do you know when your current auto insurance expires? If you don't have any current auto insurance, just let us know that. This helps us correlate potential start dates, depending on prices.
If your vehicle(s) are damaged and in the body shop getting repairs due to a claim or have been stolen (those claims usually take about 28 days to allow for police to close their file)- do you have an extra vehicle to drive? Or will you need a rental car?
*
I will need a rental car
I'm good, thanks!
If you were at fault for a car accident and you injured someone. How much money would you want the insurance company to be able to pay out on your behalf if you were sued for your liability? Make sure you consider if you permanently disable someone or kill someone- and are sued for wrongful death.
*
Imagine that someone else hit your vehicle and injured YOU or someone else in YOUR vehicle. Now imagine that they had no or had state minimum required insurance. You or your passenger (a family member) is seriously injured or even killed. Their injuries and lost wages cost considerably more than what their insurance can pay out. Your policy can pay out extra money to help you out ON TOP of whatever that driver's policy has. How much money would you want your policy to be able to pay out on YOUR BEHALF?
*
Imagine that you or another insured on your policy is in an auto accident. It doesn't matter which driver caused the accident. You might even be a pedestrian crossing the street or riding your bike and you are hit by a car. After this accident, you go to the hospital in an ambulance and have all kinds of x-rays run and get stitches and you have a broken nose, which requires some plastic surgery. You have insurance, but you haven't met your out-of-pocket maximum and the bills for your ambulance ride and hospital co-pays, deductibles, etc are piling up. Your auto insurance can set aside a little "pot of money" to cover all of these costs. How much money would you (ideally) like to have set aside? (Average: $10,000)
*
For VEHICLE 1, please select the following:
Liability only
I need coverage to repair/replace my car (sometimes called "full coverage")
I would like to add towing (about $5-$6 every 6 months)
I have a loan/lease on this car and I am curious to know how much GAP/Auto replacement coverage is
For VEHICLE 2, please select the following:
Liability only
I need coverage to repair/replace my car (sometimes called "full coverage")
I would like to add towing (about $5-$6 every 6 months)
I have a loan/lease on this car and I am curious to know how much GAP/Auto replacement coverage is
For VEHICLE 3, please select the following:
Liability only
I need coverage to repair/replace my car (sometimes called "full coverage")
I would like to add towing (about $5-$6 every 6 months)
I have a loan/lease on this car and I am curious to know how much GAP/Auto replacement coverage is
COLLISION COVERAGE: What kind of deductibles do you have for your COLLISION COVERAGE (covers you if you collide with anything). Your collision and comprehensive deductibles do not have to be equal- in fact we recommend that your comprehensive deductible be as low as possible. Collision coverage is more expensive than comprehensive, so typically people have higher deductibles for collision coverage.
$100
$250
$500
$750
$1000
Help me choose- I need a cheap policy
Help me choose- I need something kind of medium (show me a couple options)
COMPREHENSIVE COVERAGE: What kind of deductibles do you have for your COMPREHENSIVE COVERAGE (covers anything OTHER THAN collision). Examples of comprehensive claims would be: hail, trees falling on your car, theft of vehicle, theft of vehicle parts (like catalytic converters) windshield replacements, vandalism, fire, animals hitting your car (like deer or large birds), etc. Comprehensive coverage is less expensive than collision coverage and you may be MORE likely to file a comprehensive claim- so we recommend that you choose a lower deductible for comprehensive coverage.
I want comprehensive with a $0 deductible
$100
$250
$500
$750
$1000
Help me choose- show me a couple options in the LOW deductible range
Help me choose- show me a couple options in the MEDIUM deductible range
Do you need an SR22?
*
Yes
No
Do you have any questions for me- or is there anything I should know when doing your personalized proposal?
Thank you for the opportunity to protect your family!
That's it! You're done! Now all you have to do is click the SUBMIT button! If you need to email your current auto insurance documents to INFO@RICHARDSGROUPINSURANCE.COM, please do this within a week so that we can process your request most efficiently. If you need to use your current insurance company's mobile app and use screen shots of your coverages, you can either (1) email those or (because the file of photos may be too large) (2) share them via google drive or (3) text them to us at (262) 501-1340. Please also text us your name if you do this!
Submit
Should be Empty: