RMI Agency's Auto Insurance Quote Form
To apply for an Auto insurance quote complete all required fields. An agent will get back to shortly!
Date of birth
Drivers License Number?
Specify State Issue ex: AL, FL, LA
The one that you prefer to be contacted on for all things related to your quote submission and policy. We have send e-signatures to bind coverage.
Street Address Line 2
District of Columbia
Preferred Method of Contact?
If we have questions, we want to know the best way to get ahold of you.
Do you Own or Rent your Home?
It's crucial for us to know. Some of our carriers will allow us to apply a homeowner discount without requiring you to swap homeowners carriers.
Spouse Name (if none- please leave blank)
Spouse Date of birth
Spouse Drivers License Number? (if none- please leave blank)
It's crucial to list your spouse on your policy so they are covered! And for DISCOUNTS! If you need to list them but are having a hard time retrieving the DL number.(life gets busy, we get it!) Don't worry! Type in "11111111" for now. We'll need it soon though!
Teenage Driver(s) (if none- please leave blank)
Teen Drivers License Number?
For Permit Teen Drivers they are still given a license number. Type "P" to specify before typing.
Do you need to bundle your Auto Policy with Home-Boat-RV-Motorcycle?
Are all applicable drivers listed on this form?
Who is your Auto Insurance currently with?
Lapse/No Prior Coverage HELP
Progressive Local Agent Handles It
Independent Agency(not sure who)
Other Not Listed
The only reason we ask is because we use over 50 insurance carriers. It helps us streamline your quote by not quoting with the same carrier you have now!
Current or Requested Bodily Injury Limits/Property Damage
Not sure, whatever you think is best
I have no clue whatever my state allows
What are you paying monthly for your auto insurance?
You can upload your current Auto insurance pages for us to review coverages! Optional
Drag and drop files here
Choose a file
Most carriers have this information on their App or your account. Look for "my coverages or declarations" Save to phone or desktop then upload. This is optional.
I just need liability
Vehicle 1: Year, Make, Model (optional: Vin #)
Do you want full coverage on Vehicle 1?
Vehicle 2: Year, Make, Model (optional: Vin #)
Do you want full coverage on Vehicle 2?
Vehicle 3: Year, Make, Model (optional: Vin #)
Do you want full coverage on Vehicle 3?
Is there anything else you would like a quote on? When you have your home and auto insurance together you can save up to 35%!
No thanks I am all set!
If your vehicle(s) are financed we will need to list the bank on the policy.
Just type in the name of the financial institution for each vehicle. We most likely have their address already. If not we'll verify with you later.
Most of our clients are setup on automatic monthly draft from a bank account or debit/credit card. These are the cheaper options next to paying in full. What day of the month does your current payment come out?
We only ask as a courtesy. We want to make sure our effective dates on the quotes line up with when you are used to paying!
How soon do you need coverage?
NOW (if selected we will expedite)
Apply for quote
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