Auto Quote Step 1 of 2 50% Input By*Please SelectAmbassadorJessicaRobertReneeReceptionistYour Name* First Last Your Email* Your Cell Phone Number*Your Current Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Preferred Means of ContactPlease SelectPhoneEmailText MessageEmail and TextCheck the box to provide permission to receive text messages from Graves Insurance Group? (Message and Data Rates may apply)* I agree. Check the box to provide permission to receive emails from 618 Insurance.* I agree. Your Highest Level of Education*Please SelectSome 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 EducationPlease SelectSome High SchoolHigh School DiplomaSome CollegeAssociates DegreeBachelors DegreeGraduate DegreeMasters DegreeLaw DegreeMedical DegreeYour Spouse's OccupationWhat brings you to us?* Buying a new car Referred By Friend Unhappy with prior agent Concerned about my current insurance price Cancelled by prior carrier Just checking out my prices... 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? Drivers SectionHow Many Drivers in the Household*Please Select12345How do you want to provide driver's license information?*Please SelectProvide over the phone.Text photos of driver's license to (314) 668-9199Email photos to service@gravesig.com1st Insured of Birth Driver #1* MM slash DD slash YYYY Spouse Date of Birth* MM slash DD slash YYYY Name of Driver #3* First Last Date of Birth Driver #3* MM slash DD slash YYYY Name of Driver #4* First Last Date of Birth Driver #4* MM slash DD slash YYYY Name of Driver #5* First Last Date of Birth Driver #5* MM slash DD slash YYYY Vehicle SectionHow Many Vehicles do You Own?Please Select123456 +Vehicle 1* Year Make Model Vehicle 2* Year Make Model Vehicle 3* Year Make Model Vehicle 4* Year Make Model Vehicle 5* Year Make Model List Vehicles for 6+*Please get Year Make and Model of each vehicle that is over 5Accidents & ViolationsDo 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 Please SelectYesNoExplain all Accidents/Violations/Roadside Service*We Need approximate date and severity of each incident.
