Get Your Quote | Elite Insurance Group

About you

The basics so we can reach you and pull accurate rates.

First name

Last name

Date of birth

Marital status

Phone

Street address

City

State

ZIP

Years at this address

Prior address (if under 3 years)

Spouse or co-applicant (optional)

Full name

Date of birth

What would you like quoted?

Home Auto

Desired start date (optional)

Best time to reach you (optional)

Your home

If you are not sure of an answer, give your best estimate.

Is the home at the address you entered?

Home address

Type of home

Year built

Square feet (living area)

Stories

Year roof was last replaced

Roof material

Exterior walls

Foundation

Swimming pool?

Trampoline?

Dogs (breeds, if any)

Current home carrier

Policy renewal date

Current yearly premium (optional)

Mortgage company (optional)

Wind and hail deductible (from your declarations page)

Answer these and we will also quote our Wind/Hail Deductible Buy-Back, which can lower what you pay after a hail or wind claim.

Dwelling coverage (Coverage A)

Policy form

Wind/hail deductible applies to

Current wind/hail deductible

Deductible you would like (optional)

Wind or hail claims here in last 3 years

Quote the Wind/Hail Deductible Buy-Back?

Home claims in the last 5 years (type, date, amount)

Your drivers and vehicles

List everyone in the household who drives, including teens with a permit.

Drivers

Vehicles

Current auto coverage

Current auto carrier

Policy renewal date

Years continuously insured

Current liability limits

Current 6-month premium (optional)

Accidents, tickets or claims in the last 5 years (who, what, when)

Anything else?

Add anything that would help us shop, then submit.

Notes (optional)

I confirm this information is accurate and I authorize Elite Insurance Group to use it to request insurance quotes on my behalf, which may include reviewing driving and claims history reports.

We use your information only to quote your insurance. We do not sell it.

Thank you, we have it.

An agent will review your information and reach out with your options, usually within one business day.