Request a Quote | Ameristar

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General Contact Information

Name(Required)

First Last

Preferred Name

Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Years at Address(Required)

Prior Address(Required)

Street Address Address Line 2 City State ZIP Code

Years at Address at Prior Address(Required)

Months at Address at Prior Address(Required)

Home Phone

Cell Phone(Required)

Email(Required)

How did you hear about us?(Required)

If you were referred to a specific Insurance Advisor, please select their name below

If you selected 'Other", please specify their name below:

Do you have any specific requests or goals that you are trying to achieve with your new insurance plan?

Our Insurance Plan is built to take into account a comprehensive overview Insurance Profile.(Required)

In building your Insurance Plan, Ameristar Agency / MMA bundles Home and Auto together. Please select both Home & Auto, along with any other Insurance needs you may have.

Home

Auto

Umbrella

Jewelry / Collections

Motorcycle

Watercraft

ATV / Recreational Vehicle / Snowmobile

Other Insurance

Please select a quote type to continue.

Home Insurance

Owner / Resident Information

Person 1 - Owner / Primary Contact

Name(Required)

First Last

Date of Birth(Required)

Year

Month

Day

Home Phone

Cell Phone(Required)

Gender(Required)

Male

Female

Occupation & Employer Name(Required)

Total number of residents, including the Owner(s)(Required)

Is there another adult resident in the home?(Required)

If Yes, please list their name and relationship

Person 2 - Owner / Spouse / Significant Other

Name(Required)

First Last

Date of Birth(Required)

Year

Month

Day

Driver's License / State ID(Required)

Home Phone

Cell Phone(Required)

Email(Required)

Gender(Required)

Male

Female

Occupation & Employer Name(Required)

Number of Homes owned(Required)

Home Location 1 Information

Address(Required)

Street Address Address Line 2 City State ZIP Code

How will this home be used?(Required)

Primary Residence

Secondary Residence

Rental Property

Seasonal

Is there short term rental activity at this location?(Required)

Yes

Are there any businesses on the premises?(Required)

Yes

Explain

Are you in the process of purchasing this home?(Required)

If Yes, please enter your closing date below

MM slash DD slash YYYY

Year Built(Required)

Total Square Feet(Required)

Above Ground Square Feet(Required)

Square footage of your home not including the basement.

Basement Square Footage

Is the home owned by a Trust, LLC or Entity?(Required)

Yes

Please list the name of the Entity

Home Type(Required)

Single family home

Apartment

Condo

Townhouse

Twin Home

Co-op

Mobile/Manufactured

Other

Foundation(Required)

Slab

Crawl Space

Full Basement

Cellar

Elevated Post/Pier and Beam

Style of Home(Required)

2-story

Rambler

Split level

Custom

Other

Roof Material(Required)

Architechtural Shingle

Composite Shingle

Wood Shake

Concrete Tile

Clay Tile

Metal

Flat

Other

Type of Siding(Required)

Wood

Masonry

Masonry Veneer

Fire Resistive

Vinyl Siding

Aluminum Siding

Asbestos

Stucco

Log

EIFS

Hardiplank Siding

Type of Heating(Required)

Gas

Electric

Propane

Oil

Heat Pump

Geothermal

Radiant Floor

Number of Stories(Required)

Number of Full Bathrooms(Required)

Number of 3/4 Bathrooms(Required)

Number of 1/2 Bathrooms(Required)

Garage Type(Required)

Number of Garage Stalls(Required)

Are there any other special features of the Garage?

Please provide a brief description:

Is there a basement?(Required)

Yes

What percentage of basement is finished?(Required)

Please enter a number from 0 to 100.

Type of Basement(Required)

Are there any fireplaces?(Required)

Yes

Number of Fireplaces(Required)

Type of Fireplace(Required)

Fireplace Insert

Fireplace Masonry

Fireplace Prefab

Woodstove (Freestanding)

Is there currently a burglar alarm actively monitored by a company?(Required)

Is there currently a fire / temperature alarm actively monitored by a company?(Required)

Is there a fire sprinkler?(Required)

Is the home located in a gated community?(Required)

Type of kitchen(Required)

Builders Grade

Custom

Semi-custom

Other

Is there a pool?(Required)

Yes

Type of pool(Required)

Pool Square Footage(Required)

Is there a fence or pool cover around / on the pool?(Required)

Fence

Pool Cover

Neither

Is there a trampoline on the property?(Required)

Yes

List any detached structures on the property (shed, pole barn, detached garage, pool house, etc.)

Are there any current or upcoming renovation projects?(Required)

Yes

If Yes, please share the scope of the renovation project, along with the estimated cost and project timeline.

What year was the roof last updated?(Required)

What year was the heating last updated?(Required)

What year was the electrical fully replaced?

What year was the plumbing fully replaced?

Mortgage company name(Required)

Mortgage company address

Loan Number

Do you own any dogs?(Required)

Yes

If so, please list their breed below:

Does the dog have a bite history?(Required)

Yes

Do you have ownership of any other properties?(Required)

Yes

If so, please lista brief overview below

Have there been any property claims within the past 5 years?(Required)

Yes

When did they happen (if known)?

How was it remediated?

Home Location 2 Information

Address(Required)

Street Address Address Line 2 City State ZIP Code

Dwelling District(Required)

Within City Limits

Within Fire District

Within Protected Suburb

Outside City Limits

Other

Is this a primary residence or rental property?(Required)

Primary Residence

Secondary Residence

Seasonal

Is there short term rental activity at this location?(Required)

Yes

Are there any businesses on the premises?(Required)

Yes

Explain

Year built(Required)

Date of Purchase(Required)

Year

Month

Day

Total Square Feet(Required)

Above Ground Square Feet(Required)

Square footage of your home not including the basement.

Basement Square Footage

Is the home owned by a trust, LLC or entity?(Required)

Yes

Please clarify ownership

Home Type(Required)

Single Family Home

Apartment

Condo

Townhouse

Rowhouse

Co-op

Mobile/Manufactured

Other

Foundation Type(Required)

Slab

Crawl Space

Full Basement

Cellar

Elevated Post/Pier and Beam

Style of Home(Required)

2-story

Rambler

Split level

Roof Material(Required)

Architechtural Shingle

Composite Shingle

Wood Shake/Shingle

Concrete Tile

Clay Tile

Metal

Flat

Built Up

Other

Type of Siding(Required)

Frame

Masonry

Masonry Veneer

Fire Resistive

Aluminum Siding

Asbestos

Stucco

Log

EIFS

Hardiplank Siding

Type of Heating(Required)

Gas

Electric

Propane

Oil

Heat Pump

Geothermal

Radiant Floor

Number of Stories(Required)

Number of Full Bathrooms(Required)

Number of 3/4 Bathrooms(Required)

Number of 1/2 Bathrooms(Required)

Garage Type(Required)

Number of Garage Stalls(Required)

Number of Cars Garaged(Required)

The number of cars that fit within the garage of the home.

Are there any other special features of the Garage?

Please provide a brief description:

Is there a basement?(Required)

Yes

What percentage of basement is finished?(Required)

Type of Basement(Required)

Are there any fireplaces?(Required)

Yes

Number of Fireplaces(Required)

Type of Fireplace(Required)

Fireplace Insert

Fireplace Masonry

Fireplace Prefab

Is there currently a burglar alarm actively monitored by a company?(Required)

Is there currently a fire / temperature alarm actively monitored by a company?(Required)

Is there a fire sprinkler?(Required)

Is the home located in a gated community?(Required)

Type of Kitchen(Required)

Builders Grade

Custom

Semi-custom

Other

Is there a pool?(Required)

Yes

Type of Pool(Required)

Pool Square Footage(Required)

Is there a fence around the pool?(Required)

Yes

Is there a trampoline on the property?(Required)

Yes

List any detached structures on the property (shed, pole barn, detached garage, pool house, etc.)

Square Footage of Detached Structures

Are there any current or upcoming renovation projects?(Required)

Yes

Describe the Project

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Approximate Cost

What year was the roof last updated?(Required)

What year was the heating last updated?(Required)

What year was the electrical fully replaced?(Required)

What year was the plumbing fully replaced?(Required)

Mortgage Company Name(Required)

Mortgage Company Address(Required)

Loan Number

Are there any residents in the home that are not listed?(Required)

Yes

List All Additional Residents

Do you own any dogs?(Required)

Yes

If yes, please list their breed below:

Does the dog have a bite history?(Required)

Yes

Do you have ownership of any other properties?(Required)

Yes

Have there been any property claims within the past 5 years?(Required)

Yes

When did they happen (if known)?

How was it remediated?

Vehicle Insurance

How many licensed drivers reside in the home?(Required)

How many cars will be covered under this insurance policy?(Required)

Driver 1

Name(Required)

First Last

Relationship(Required)

If "Other", please specify:

Date of Birth(Required)

Year

Month

Day

Gender(Required)

Male

Female

Cell Phone(Required)

Drivers License Type(Required)

Driver's License / Permit License Number(Required)

State that Issued License(Required)

State

Driver's License Status(Required)

Licensed

Not Licensed

Permit

Suspended

Is this driver a student?(Required)

Yes

Is this driver away at school over 100 miles from your home?(Required)

Yes

What is the location? (Provide address if possible.)(Required)

Does this driver have a vehicle with them at school?(Required)

Yes

Does this driver maintain a B average or better in school?(Required)

Yes

Driver 2

Name(Required)

First Last

Relationship(Required)

If "Other", please specify:

Date of Birth(Required)

Year

Month

Day

Gender(Required)

Male

Female

Cell Phone(Required)

Driver's License / Permit License Number(Required)

Drivers License Type(Required)

State that Issued License(Required)

State

Driver's License Status(Required)

Licensed

Not Licensed

Permit

Suspended

Is this driver a student?(Required)

Yes

Is this driver away at school over 100 miles from your home?(Required)

Yes

What is the location? (Provide address if possible.)(Required)

Does this driver have a vehicle with them at school?(Required)

Yes

Does this driver maintain a B average or better in school?(Required)

Yes

Driver 3

Name(Required)

First Last

Relationship(Required)

If "Other", please specify:

Date of Birth(Required)

Year

Month

Day

Gender(Required)

Male

Female

Cell Phone(Required)

Driver's License / Permit License Number(Required)

Drivers License Type(Required)

State that Issued License(Required)

State

Driver's License Status(Required)

Licensed

Not Licensed

Permit

Suspended

Is this driver a student?(Required)

Yes

Is this driver away at school over 100 miles from your home?(Required)

Yes

What is the location? (Provide address if possible.)(Required)

Does this driver have a vehicle with them at school?(Required)

Yes

Does this driver maintain a B average or better in school?(Required)

Yes

Driver 4

Name(Required)

First Last

Relationship(Required)

If "Other", please specify:

Date of Birth(Required)

Year

Month

Day

Gender(Required)

Male

Female

Cell Phone(Required)

Driver's License / Permit License Number(Required)

Drivers License Type(Required)

State that Issued License(Required)

State

Driver's License Status(Required)

Licensed

Not Licensed

Permit

Suspended

Is this driver a student?(Required)

Yes

Is this driver away at school over 100 miles from your home?(Required)

Yes

What is the location? (Provide address if possible.)(Required)

Does this driver have a vehicle with them at school?(Required)

Yes

Does this driver maintain a B average or better in school?(Required)

Yes

Driver 5

Name(Required)

First Last

Relationship(Required)

If "Other", please specify:

Date of Birth(Required)

Year

Month

Day

Gender(Required)

Male

Female

Cell Phone(Required)

Driver's License / Permit License Number(Required)

Drivers License Type(Required)

State that Issued License(Required)

State

Driver's License Status(Required)

Licensed

Not Licensed

Permit

Suspended

Is this driver a student?(Required)

Yes

Is this driver away at school over 100 miles from your home?(Required)

Yes

What is the location? (Provide address if possible.)(Required)

Does this driver have a vehicle with them at school?(Required)

Yes

Does this driver maintain a B average or better in school?(Required)

Yes

Driver 6

Name(Required)

First Last

Relationship(Required)

If "Other", please specify:

Date of Birth(Required)

Year

Month

Day

Gender(Required)

Male

Female

Cell Phone(Required)

Driver's License / Permit License Number(Required)

Drivers License Type(Required)

State that Issued License(Required)

State

Driver's License Status(Required)

Licensed

Not Licensed

Permit

Suspended

Is this driver a student?(Required)

Yes

Is this driver away at school over 100 miles from your home?(Required)

Yes

What is the location? (Provide address if possible.)(Required)

Does this driver have a vehicle with them at school?(Required)

Yes

Does this driver maintain a B average or better in school?(Required)

Yes

Vehicle 1

Year(Required)

Make(Required)

Model(Required)

VIN(Required)

Primary Driver(Required)

Is this vehicle parked / stored in garage at the primary location?(Required)

Yes

If No, please list address of where this vehicle is garaged

Vehicle Usage(Required)

Number of Days Driven per Week(Required)

Distance Driven One Way for Commute(Required)

Please enter a number greater than or equal to 0.

Annual mileage(Required)

Is this vehicle used to deliver goods or as a transportation service (Uber / Lyft)?(Required)

Yes

Have there been any claims or driving infractions in the past five years?

Is there a loan or lease on this vehicle?(Required)

Yes

Have there been any auto claims in the past 5 years?(Required)

Yes

When were the claims made (if known)?

Describe your claim

Vehicle 2

Year(Required)

Make(Required)

Model(Required)

VIN(Required)

Is this vehicle parked / stored in garage at the primary location?(Required)

Yes

If No, please list address of where this vehicle is garaged

Primary Driver(Required)

Vehicle Usage(Required)

Number of Days Driven per Week(Required)

Distance Driven One Way for Commute(Required)

Please enter a number greater than or equal to 0.

Annual mileage(Required)

Is this vehicle used to deliver goods or as a transportation service (Uber / Lyft)?(Required)

Yes

Have there been any claims or driving infractions in the past five years?

Is there a loan or lease on this vehicle?(Required)

Yes

Have there been any auto claims in the past 5 years?(Required)

Yes

When were the claims made (if known)?

Describe your claim

Vehicle 3

Year(Required)

Make(Required)

Model(Required)

VIN(Required)

Is this vehicle parked / stored in garage at the primary location?(Required)

Yes

If No, please list address of where this vehicle is garaged

Primary Driver(Required)

Vehicle Usage(Required)

Number of Days Driven per Week(Required)

Distance Driven One Way for Commute(Required)

Please enter a number greater than or equal to 0.

Annual mileage(Required)

Is this vehicle used to deliver goods or as a transportation service (Uber / Lyft)?(Required)

Yes

Have there been any claims or driving infractions in the past five years?

Is there a loan or lease on this vehicle?(Required)

Yes

Have there been any auto claims in the past 5 years?(Required)

Yes

When were the claims made (if known)?

Describe your claim

Vehicle 4

Year(Required)

Make(Required)

Model(Required)

VIN(Required)

Is this vehicle parked / stored in garage at the primary location?(Required)

Yes

If No, please list address of where this vehicle is garaged

Primary Driver(Required)

Vehicle Usage(Required)

Number of Days Driven per Week(Required)

Distance Driven One Way for Commute(Required)

Please enter a number greater than or equal to 0.

Annual mileage(Required)

Is this vehicle used to deliver goods or as a transportation service (Uber / Lyft)?(Required)

Yes

Have there been any claims or driving infractions in the past five years?

Is there a loan or lease on this vehicle?(Required)

Yes

Have there been any auto claims in the past 5 years?(Required)

Yes

When were the claims made (if known)?

Describe your claim

Vehicle 5

Year(Required)

Make(Required)

Model(Required)

VIN(Required)

Is this vehicle parked / stored in garage at the primary location?(Required)

Yes

If No, please list address of where this vehicle is garaged

Primary Driver(Required)

Vehicle Usage(Required)

Number of Days Driven per Week(Required)

Distance Driven One Way for Commute(Required)

Please enter a number greater than or equal to 0.

Annual mileage(Required)

Is this vehicle used to deliver goods or as a transportation service (Uber / Lyft)?(Required)

Yes

Have there been any claims or driving infractions in the past five years?

Is there a loan or lease on this vehicle?(Required)

Yes

Have there been any auto claims in the past 5 years?(Required)

Yes

When were the claims made (if known)?

Describe your claim

Vehicle 6

Year(Required)

Make(Required)

Model(Required)

VIN(Required)

Is this vehicle parked / stored in garage at the primary location?(Required)

Yes

If No, please list address of where this vehicle is garaged

Primary Driver(Required)

Vehicle Usage(Required)

Number of Days Driven per Week(Required)

Distance Driven One Way for Commute(Required)

Please enter a number greater than or equal to 0.

Annual mileage(Required)

Is this vehicle used to deliver goods or as a transportation service (Uber / Lyft)?(Required)

Yes

Have there been any claims or driving infractions in the past five years?

Is there a loan or lease on this vehicle?(Required)

Yes

Have there been any auto claims in the past 5 years?(Required)

Yes

When were the claims made (if known)?

Describe your claim

Do you have any other items to insure?(Required)

Rental Property

Motorcycle/ATV

Snowmobile

Boat

Jewelry/Collectibles

Additional Residences

Other

If you have other items to insure, please provide a high-level description of those items

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First Choice

Second Choice

Third Choice

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