Classic Car Insurance Clearwater FL - Bay Area Insurance Shop

Full Legal Name*

First Last Suffix

Current Address*

Street Address Address Line 2 City State ZIP Code

Phone*

May we text you about your quote?*

We'll never text for solicitation purposes, only about your quote or policy information. It's a great way to obtain quick information if we have a quick question.

Email*

Insurance Score Approval*

Please note in order to get an accurate quote, the majority of insurance companies run an insurance score which includes a soft credit inquiry. By completing this form you are authorizing Bay Area Insurance Shop and it's companies to complete any requested quotes.

I agree

Document Upload

This is not required, but if readily available, please upload your most current insurance policy coverage declarations pages in PDF format so we can see the exact coverage limits you'd like us to compare. These can be easily downloaded from your online profile with your current provider (if you have a login) or from your current agent.

Max. file size: 39 MB.

Driver Information

Please list personal information for all drivers in your household

How Many Drivers?*

Please choose the number of drivers who need to be listed for your insurance. All licensed drivers in your household should be listed.

Daily Use Vehicles*

How many daily use vehicles, excluding classic/exotic, do you own?

Primary Residence*

Own Home/Condo
Own Manufactured Home
Rent

Name - Driver 1

First Last

Sex*

Male
Female

Occupation*

Highest Level of Education Completed*

Date of Birth - Driver 1*

Drivers License Number & State Driver 1*

Does this driver have claims/accidents or tickets in the last 5 years?

Name - Driver 2

First Last

Sex*

Male
Female

Occupation*

Highest Level of Education Completed*

Date of Birth - Driver 2

Drivers License Number & State Driver 2

Does this driver have claims/accidents or tickets in the last 5 years?

Name - Driver 3

First Last

Sex*

Male
Female

Occupation*

Date of Birth - Driver 3

Drivers License Number & State Driver 3

Does this driver have claims/accidents or tickets in the last 5 years?

Name - Driver 4

First Last

Sex*

Male
Female

Occupation*

Date of Birth - Driver 4

Drivers License Number & State Driver 4

Does this driver have claims/accidents or tickets in the last 5 years?

Name - Driver 5

First Last

Sex*

Male
Female

Occupation

Date of Birth - Driver 5

Drivers License Number & State Driver 5

Does this driver have claims/accidents or tickets in the last 5 years?

Vehicle Information

How Many Vehicles Need to be Insured?

Vehicle Year, Make, Model*

Vehicle Value*

Annual Mileage*

Daily Auto Insurance Limits*

Please provide the limits of liability coverage on your personal auto insurance

Year, Make & Model-Vehicle 2*

Vehicle Value*

Annual Mileage

Year, Make & Model-Vehicle 3*

Vehicle Value*

Annual Mileage

Who Is Your Current Insurance Company & How Many Years Have You Been With Them?*

Effective Date of Policy*

Please provide current premium

Who referred you to Bay Area Insurance Shop?*

The majority of our business comes from referrals! Who can we thank for referring you to our agency?

Classic Car Insurance

Collector & Antique Car Insurance

YOUR PASSION, OUR PASSION

Classic/Exotic Auto Form

Driver Information

Vehicle Information