Advantage Insurance Group Home & Auto Quote
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| Applicant Name
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| Address
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| If you've lived in your home for less than 3 years, please list your previous address
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| Home Phone
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| Cell Phone
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| Email
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| Preferred method of contact
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| Applicant Date of Birth
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| Applicant Social Security #
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| Applicant Drivers License #
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| Applicant Occupation
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| Spouse Name
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| Spouse Date of Birth
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| Spouse Social Security #
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| Spouse DL#
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| Spouse Occupation
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Home Information
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| Value of Home
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| Square Footage of home
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| Year Built
| If you home is over 20 years old, please complete the questions below regarding updates
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| Year wiring was updated
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| Year plumbing was updated
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| Year heating unit was updated
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| Number of stories
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| Construction Type
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| Year Roof installed
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| Type of Roof
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| Number of Bedrooms
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| Number of Bathrooms
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| Home Foundation Type:
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| Do you have a swimming pool?
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| Do you have a trampoline?
| Yes No
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| Fireplace?
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| Type of Heating Unit:
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| Garage size and type
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| Alarm system?
| None Monitored Local Alert Only
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| If you have dogs, please list number of dogs and their breed.
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| If you run any sort of business from your home, please list it here in detail.
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| Please list any claims you have had over the past 5 years. Dates, amount paid, type of loss
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| Current Insurance Provider
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| Expiration date of current policy
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| Please list any scheduled valuables you would like quoted on the policy or any other information you feel we should know.
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| Are you purchasing this home?
| Yes No
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| If this is a new purchase, please list your current address:
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| Please list your Mortgagee information, including mailing address.
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Auto Information
Please note VIN numbers are required for all vehicles.
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| Please list name, SS#, DOB, and DL# for any household driver other than applicant & spouse
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| Year, Make, Model of Vehicle 1
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| VIN number for vehicle 1
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| Driver of Vehicle 1
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| Comprehensive/Collision coverage with deductible for Vehicle 1?
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| Year, Make, Model of Vehicle 2
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| VIN number for vehicle 2
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| Driver of Vehicle 2
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| Comprehensive/Collision coverage with deductible for Vehicle 2?
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| Requested Liability Limits for all vehicles (our agency minimum is $50,000/$100,000)
| $50,000/$100,000 $100,000/$300,000 $250,000/$500,000
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| Please list any claims, tickets, and accidents. Put the driver and vehicle involved, along with the type of incident and date of occurance
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| Are the vehicles currently insured?
| Yes No
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| Current Insurance Provider
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| Expiration date of current policy
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| If you have more than 2 vehicles, please list additional year, make, model, VIN, and comprehensive/collision choice here
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