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Home & Auto Insurance Information
This is where beautiful partnerships begin. We can't wait to help you!
Step
1
of
4
25%
Your Name
*
First
Last
Are you a Shine client already?
*
Yes
No
Phone
*
How'd you hear about Shine?
*
Lender/Realtor
Shine Client
Other
Which Lender/Realtor can we thank?
*
Which client can we thank?
*
How did you find us?
*
Email
*
Your Birthday
*
Where do you work?
*
This can sometimes provide a discount.
What is your job title?
*
How many days a week do you drive to work?
*
None (I work remotely or take public transportation)
1-3
4-5
Do you have a spouse or partner living with you?
*
Yes
No
Spouse or Partner Name
*
First
Last
Spouse or Partner Phone
Helpful but not necessary
Spouse or Partner Email
Helpful but not necessary
Spouse or Partner Birthday
*
Where does your spouse or partner work?
*
Discount may apply
What is their job title?
*
How many days a week do you drive to work?
*
None (I work remotely or take public transportation)
1-3
4-5
Are you married?
*
Yes
No
Discount may apply
Do you:
*
Own your home
Rent your home
Own your condo
Are you buying a new home?
*
Yes
No
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Current Address (where you live now)
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
New Address (The home you're buying)
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Which bank helps you with your mortgage?
*
This helps us make sure they get the right documents
What year was your roof replaced (some companies require proof)?
*
Is your HVAC less than 15 years old?
*
Yes
No
Do you have a dog?
*
Yes
No
What kind of dog (ballpark)
*
Which of the below do you have:
*
Detached Garage / Pole Barn
Pool
Finished Basement
Woodstove
Security System
Trampoline
None
What size is the detached garage / pole barn?
*
give us a ballpark idea
Does the trampoline have a safety net?
Yes
No
Is the pool:
In Ground
Above Ground
Does the pool have:
*
Diving Board
Slide
Neither
Does the pool have a fence or electric cover?
*
Yes
No
How deep is the deepest part of the pool?
*
Do you have a sump pump?
*
Yes
No
Does the sump pump have battery backup?
*
Yes
No
What type of Security System?
*
Do you have any valuable collectibles?
*
Yes
No
Think jewelry, fine art, vintage vehicles, etc.
Please share the collectibles value and description
*
Any home claims in the last 5 years?
*
Yes
No
Please explain the claims
*
What cars need insured? (year/make/model)
*
Are there any additional drivers in your home?
*
Yes
No
Name & Birthdate of any additional drivers in your home
*
What is your Driver License Number and State?
Are any drivers your children?
Yes
No
Do they have a B average in school or higher?
Yes
No
Do any cars have loans on them?
*
Yes
No
Which cars & who is the lender?
Any auto claims in the last 5 years?
*
Yes
No
Please explain claims
*
Attach your current policies or other supporting docs
Drop files here or
Select files
Max. file size: 50 MB.
Attaching your policy gets you a free apples to apples comparison. You’ll still get a quote without uploading your docs. But if you want the best Shine experience, go ahead and drop those files.
Additional Information
You can give us lots of details or just a few.
Text Notification
By completing this form you consent to text communication from one human to another. Nothing automated just your friendly insurance advisor reaching out to chat.
Comments
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