Start Your Quotes in Seconds! - Bay Area Insurance Shop

Full Legal Name*

First Last Suffix

Address for Requested Quote*

Street Address Address Line 2 City State ZIP Code

Current Address*

Street Address Address Line 2 City State ZIP Code

Prior Address (If less than 5 years at 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.

I agree

What would you like a quote for?*

Auto Only
Home Only
Renters Only
Auto and/or Home/Renters
Umbrella & Excess Liability
Investment / Rental Property
Flood Insurance
Watercraft
Motorcycle /ATV

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.

Driver Information

Please list personal information for all drivers in your household if you need auto insurance.

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.

Primary Residence*

Own Home/Condo
Own Manufactured Home
Rent

Do any household drivers:*

Use their vehicle for business purposes
Drive for Uber/Lyft or any RideShare
Deliver Packages for Amazon/Shipt/Other Delivery Services
Deliver Meals/Food (ie: GrubHub, Uber Eats, DoorDash/Pizza)
Participate in Turo
Nobody has business use, drives rideshare, delivers food or packages or participates in Turo

Name - Driver 1

First Last

Sex*

Male
Female

Occupation*

Highest Level of Education Completed*

Date of Birth - Driver 1*

MM

DD

YYYY

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

MM

DD

YYYY

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

MM

DD

YYYY

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

MM

DD

YYYY

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

MM

DD

YYYY

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 ID (VIN) Number-Vehicle 1*

Lienholder (Bank) Name*

Vehicle Use*

How Much Coverage Should Be Quoted? (Vehicle #1)

Liability Only
Liability, Comprehensive & Collision

Vehicle Identification (VIN) Number-Vehicle 2*

Lienholder Name*

Vehicle Use*

How Much Coverage Should Be Quoted? (Vehicle #2)

Liability Only
Liability, Comprehensive & Collision

Vehicle Identification (VIN) Number-Vehicle 3

Lienholder (Bank) Name*

Vehicle Use*

How Much Coverage Should Be Quoted? (Vehicle #3)

Physical Damage
Liability Only

Vehicle Identification (VIN) Number-Vehicle 4

Lienholder Name*

Vehicle Use*

How Much Coverage Should Be Quoted? (Vehicle #4)

Physical Damage- Including Comprehensive & Collision Coverage
Liability Only

Which of the Following Coverage's Should Be Included?

Towing
Rental Car
Towing and Rental Car
None of the Above

Please provide a summary of claims, accidents or tickets for each household driver*

Please include dates of incident and amount of claim if known.

Current Policy Liability Limits*

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

Please provide current premium

Preferred Payment Option

Home Owner Information

How many people are on the deed or the rental agreement?

The home will be deeded to:

Please provide name of Trust or LLC

Legal Name of First Deeded Owner/Renter

First Last

Sex*

Male
Female

Date of Birth*

MM

DD

YYYY

Legal Name of Second Deeded Owner

First Last

Relationship

Sex*

Male
Female

Date of Birth*

MM

DD

YYYY

Has any deeded owner had a foreclosure, bankruptcy, lien or judgement in the past 5 years?*

Yes, Owner 1
Yes, Owner 2
Yes, Both Deeded Owners
Nobody has this

Property Information

Is this a new purchase?*

Effective Date of Policy*

Closing date if new purchase or renewal date of current policy

Is there/will there be a mortgage on the home?

Contact Info for Mortage Company

Please provide name, phone & fax for a contact for the mortgage company.

Current Homeowners Insurance Carrier*

If this is not a new purchase, what company currently insures your property?

This home will be used as a*

Primary Residence
Seasonal/Secondary Residence
Non-Owner Occupied/Rental Property

Please describe the home style

Please provide Manufacturer & Dimensions

Value of the home

Provide the insurance amount you're considering purchasing or the cost to replace this home.

Mobile Home Land Information

Located on Private Property
55+ Mobile Home Park (Land Owned By Me)
55+ Mobile Home Park (Do not own land)
Located in family park

Name of Mobile Home Park

Please provide information for additions or upgrades

Provide sizes of screen enclosures, carports, etc

Year Built

Square Footage

Exterior Finish of Home

Year of Last Roof Update*

Please provide Wind Mitigation Inspection if current in the last five years.

Homes 15 and older: Water Heater Year

Please Provide a Current Four Point Inspection If Home Is Over 40 years old.*

Not Over 40 Years Old
Will Upload Inspection
Request a referral for home inspector to do this

Alarm System Present?

Interested in a referral for alarm service
Yes, Installed and Monitored through Central Station Monitoring Service (please upload monitoring certificate for discount)
Yes, Installed but not monitored
No

Is There a Swimming Pool Present?

Yes
No

Is your home community gated or does it have a single entry point?*

If you have pets, please advise what breed of any dogs.*

Please let us know if any of these apply*

Please let us know if any of these apply to any property you may own or rent.

Any breed or mix of the following dog breeds: Akita, American Bulldog, American Staffordshire Terrier, Belgian Malinos, Bull Terrier, Cane Corso, Caucasian Mountain Dog, Chow, Doberman Pinscher, Dutch Shepherd, German Shepherd, Mastiff, Olde English Bulldog, Pit Bull, Presa Canario, Rottweiler, Staffordshire Terrier, Wolf/Wolf Hybrid?
Any dogs that have been trained for guard or attack purposes
Any dog used in military or police work
Unfenced or Unscreened Pool
Diving Board, Pool Slide or Trampoline
Mini-Bikes, ATV, Dirt Bike
Farm Animals
I do not have any of the above liability exposures.

Have you experienced any claims on any property in the past 5 years?*

Please provide date, property address and details if yes in the Coverage Details box below.

Yes
No

Claim Details

Please provide a description of the claim including date of loss, amount of claim and if the repair work has been completed & the claim has been closed.

Is there any additional information that would assist us with your quotes?

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?

Website Quote Request

Driver Information

Vehicle Information

Home Owner Information

Property Information