Auto and Home Quote Step 1 of 3 33% Input By*Please SelectAmbassadorJessicaRobertReneeReceptionistYour Name* First Last Your Email* Check the box to provide permission to receive emails from 618 Insurance.* I agree. Your Cell Phone Number*Your Current Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Preferred Means of Contact* Email Phone Text Message Check the box to provide permission to receive text messages from Graves Insurance Group? (Message and Data Rates may apply)* I agree. Your Highest Level of Education*Some High SchoolHigh School DiplomaSome CollegeAssociates DegreeBachelors DegreeGraduate DegreeMasters DegreeLaw DegreeMedical DegreeYour Occupation*Your Marital StatusPlease SelectSingleMarriedDivorced/SeparatedWidowedSpouse's/Significant Other's Name First Last Your Spouse/Significant Other's Highest Level of EducationSome High SchoolHigh School DiplomaSome CollegeAssociates DegreeBachelors DegreeGraduate DegreeMasters DegreeLaw DegreeMedical DegreeYour Spouse's OccupationWhat brings you to us?* Buying a new home Referred By Friend Unhappy with prior agent Concerned about my current insurance price Cancelled by prior carrier Just checking out my prices... HEARD AWESOME THINGS ABOUT GRAVES INSURANCE! What type of insurance are you seeking? Home Insurance Auto Insurance Umbrella Insurance Motorcycle Insurance Boat Insurance Do you currently have insurance?* Yes No I haven't needed it before Name of current carrierHow many years have you been with your current carrier? Home Insurance SectionYou ____ the home you live in. Own Own with Mortgage Rent Live with someone else who owns/pays rent What is the approximate square footage of your home?Does your home have any of the following? Trampoline Pool Home Insurance claims in the past Dog(s) Exotic Pets Is your trampoline... in a fenced yard. staked in the ground. surrounded by a net. Does your pool have... a fence a diving board a slide a permanent ladder a removable ladder. in ground above ground How many dogs do you have?Have any of your dogs/other pets previously bitten anyone?* Yes No Are you willing to exclude animal bites from your home's liability coverage?* Yes No Breed of dog 1Breed of dog 2Breed of dog 3What kind of exotic pet?How old is your roof?How old is Heating/Air Conditioning?How old is the electrical?How is the electrical system controlled? Circuit Breakers - metal box with switches Fuse Box - metal box where you screw in fuses Does your home's electrical system have:* Knob and Tube wiring Romex wiring Electrical Service less than 200 Amps None of the above Auto Insurance SectionHow many drivers in your household?How do you want to provide driver's license information? Provide over the phone. Text photos of driver's license to (314) 668-9199 Email photos to service@gravesig.com Name of Driver #1 First Last Driver #1 Date of Birth MM slash DD slash YYYY Driver's License Number for Driver #1Name of Driver #2 First Last Driver #2 Date of Birth MM slash DD slash YYYY Driver's License Number for Driver #2Name of Driver #3 First Last Driver #3 Date of Birth MM slash DD slash YYYY Driver's License Number for Driver #3Name of Driver #4 First Last Driver #4 Date of Birth MM slash DD slash YYYY Driver's License Number for Driver #4Name of Driver #5 First Last Driver #5 Date of Birth MM slash DD slash YYYY Driver's License Number for Driver #5How many cars do you own?What type of car #1? (year/make/model)VIN Number for car #1Car #1 is: Owned outright has a loan on it. is leased. What type of car #2? (year/make/model)VIN Number for car #2Car #2 is: Owned outright has a loan on it. is leased. What type of car #3? (year/make/model)VIN Number for car #3Car #3 is: Owned outright has a loan on it. is leased. What type of car #4? (year/make/model)VIN Number for car #4Car #4 is: Owned outright has a loan on it. is leased. What type of car #5? (year/make/model)VIN Number for car #5Car #5 is: Owned outright has a loan on it. is leased. Do any of your household drivers have the following: Moving Violations/Tickets over the past five years Motor Vehicle accidents in the past five year Roadside Assistance claims over the past five years
