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Questions For Quote

Questions For QuoteCollin Randlolph2021-12-03T19:36:05+00:00

Step 1 of 4

25%

General Contact Information

Name
Date
Current Address
What type of quote are you interested in?
Please note that for the most competitive rates a bundled insurance package of home and auto is required.

Please select a quote type to continue.

Home Insurance

Owner / Resident Information

Name
Date of Birth(Required)
Name
Date of Birth

Home Location 1 Information

Address
Is this a primary residence or rental property?
Is there short term rental activity at this location?
Are there any businesses on the premises?
Date of Purchase(Required)
Home Type
Foundation Type
Style of Home

Roof Material
Type of Siding
Type of Heating
The number of cars that fit within the garage of the home.
Is there a basement?
Please enter a number from 0 to 100.
Are there any fireplaces?
Type of Fireplace
Do you own any dogs?
Does the dog have a bite history?
Is there an alarm system?
What type of alarm?
Is there water or temperature monitoring?
Type of kitchen

Is there a pool?
Is there a fence around the pool?
Is there a trampoline on the property?
Are there any current or upcoming renovation projects?
Are there any residents in the home that are not listed?

Home Location 2 Information

Address
Is this a primary residence or rental property?
Is there short term rental activity at this location?
Are there any businesses on the premises?
Date of Purchase(Required)
Home Type

Foundation Type
Style of Home
Roof Material
Type of Siding
Type of Heating
The number of cars that fit within the garage of the home.
Is there a basement?
The number of cars that fit within the garage of the home.
Are there any fireplaces?
Type of Fireplace
Do you own any dogs?
Does the dog have a bite history?
Is there an alarm system?
What type of alarm?
Is there water or temperature monitoring?
Type of Kitchen
Is there a pool?
Is there a fence around the pool?
Is there a trampoline on the property?
Are there any current or upcoming renovation projects?
Are there any residents in the home that are not listed?

Vehicle Insurance

Driver 1

Name(Required)
Date of Birth(Required)
State that Issued License(Required)
Is this driver a student?
Is this driver away at school over 100 miles from your home?
Does this driver have a vehicle with them at school?
Does this driver maintain a B average or better in school?

Driver 2

Name
Date of Birth
State that Issued License
Is this driver a student?
Is this driver away at school over 100 miles from your home?
Does this driver have a vehicle with them at school?
Does this driver maintain a B average or better in school?

Driver 3

Name
Date of Birth
State that Issued License
Is this driver a student?
Is this driver away at school over 100 miles from your home?
Does this driver have a vehicle with them at school?
Does this driver maintain a B average or better in school?

Driver 4

Name
Date of Birth
State that Issued License
Is this driver a student?
Is this driver away at school over 100 miles from your home?
Does this driver have a vehicle with them at school?
Does this driver maintain a B average or better in school?

Driver 5

Name
Date of Birth
State that Issued License
Is this driver a student?
Is this driver away at school over 100 miles from your home?
Does this driver have a vehicle with them at school?
Does this driver maintain a B average or better in school?

Driver 6

Name
Date of Birth
State that Issued License
Is this driver a student?
Is this driver away at school over 100 miles from your home?
Does this driver have a vehicle with them at school?
Does this driver maintain a B average or better in school?

Vehicle 1

Was vehicle purchased new?
Vehicle usage (select all that apply)
Is this vehicle used to deliver goods or as a transportation service (Uber / Lyft)?

Vehicle 2

Was vehicle purchased new?
Vehicle usage (select all that apply)
Is this vehicle used to deliver goods or as a transportation service (Uber / Lyft)?

Vehicle 3

Was vehicle purchased new?
Vehicle usage (select all that apply)
Is this vehicle used to deliver goods or as a transportation service (Uber / Lyft)?

Vehicle 4

Was vehicle purchased new?
Vehicle usage (select all that apply)
Is this vehicle used to deliver goods or as a transportation service (Uber / Lyft)?

Vehicle 5

Was vehicle purchased new?
Vehicle usage (select all that apply)
Is this vehicle used to deliver goods or as a transportation service (Uber / Lyft)?

Vehicle 6

Was vehicle purchased new?
Vehicle usage (select all that apply)
Is this vehicle used to deliver goods or as a transportation service (Uber / Lyft)?
Do you have any other items to ensure?

AmeriStar Agency
815 Wayzata Blvd E
Wayzata, MN 55391

763-542-8377

info@ameristaragency.com

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