Section 1 of 5

About You

Tell us who's insuring the vehicle(s). We'll use this to prefill the primary driver on the next step.

Applicant

First Name*

Last Name*

Date of Birth*

Gender*

Email*

I confirm this email is correct

Mobile Phone*

I confirm this number is correct

I agree to receive text messages regarding my quote request. Message and data rates may apply. Message frequency varies. Reply STOP to opt out at any time. Consent is not a condition of purchase.

Address

Physical Street Address*

City*

State*

ZIP*

Mailing address same as physical address

USPS couldn't fully confirm this address. Double-check the street, city, and ZIP for typos, or confirm below to continue anyway.

I confirm this address is correct

Coverage Start Date

When would you like your policy to start?*

Your Household

How many vehicles does your household own for daily driving that will NOT be quoted as enthusiast vehicles here today?*

Collector Insurance Background

Current Insurance Provider

Car Club Membership

Section 2 of 5

Your Vehicle(s)

Add each collector vehicle you want quoted.

Vehicle 1

Vehicle Type*

Model Year*

Make*

Model*

Sub-model

Body Style*

Doors*

Value & VIN

Estimated Value*

VIN (optional for your quote)

Modifications

Engine horsepower has increased by 50 hp or more from stock

Vehicle has custom paint such as artwork, flames, pearl or graphics

Vehicle is a replica of another vehicle

Vehicle has custom rims 22" or larger, or rims have 100 spokes or more

Vehicle frame has been structurally modified

Vehicle has been tubbed to accommodate larger wheels and has a roll cage installed

Vehicle has custom hydraulics, or an air suspension installed

Is the vehicle under active restoration?*

Does any of the following describe this vehicle?*

Usage

Registration Type*

Who is the vehicle registered to?*

Are you transferring license plates from another vehicle you own to this one?*

How long have you owned the vehicle?*

Is this vehicle owned/leased/financed?*

How many miles per year will you drive the vehicle?*

Is this vehicle used as your primary vehicle for daily transportation?*

Is the vehicle used for racing?*

Is the vehicle used for off-roading?*

Is the vehicle used for business purposes?*

Storage

Is the vehicle stored in any of the following locations?
(Private garage, barn, car condo, private parking garage, pole building)*

Garaging Location

Where is this vehicle garaged?*

Section 3 of 5

Drivers

Please add all licensed drivers in your household.

Driver 1

First Name

Last Name

Date of Birth

Gender

Phone

Marital Status*

Relationship to Insured

Relationship to Insured*

Driver's License Number (optional)

Issue State*

How many years has this driver been licensed?*

How many points are currently on this driver's license?*

Do you have your own regular use vehicle for daily driving that is not the collector vehicle? (Motorcycles are not considered daily-use vehicles)*

Has the driver had any traffic violations within the past five years?*

Has the driver had any accidents, insurance claims, or vehicle thefts within the past five years?*

Is your daily use vehicle a company provided vehicle?*

Operates the Collector Vehicle?*

Section 4 of 5

Coverage Preferences

Choose your coverage limits and options below. These apply to your whole policy and each vehicle.

Policy-Level Coverage

Bodily Injury Liability*

Property Damage Liability*

Include Medical Payment coverage?*

Medical Payment*

Uninsured Motorist Bodily Injury*

Uninsured Motorist Property Damage*

Include Underinsured Motorist coverage?*

Section 5 of 5

Review & Submit

You're almost done. Review the consent below, then submit to get your quotes started.

Consent

I confirm that the information provided is accurate to the best of my knowledge, and I understand that our insurance company partners may obtain insurance reports, including motor vehicle records and prior claims history, to evaluate my application and determine my rate.

We Shop.
You Drive.

Is Shopt right for you?

About You

Your Vehicle(s)

Drivers

Coverage Preferences

Review & Submit

We Shop.You Drive.

Is Shopt right for you?

About You

Your Vehicle(s)

Drivers

Coverage Preferences

Review & Submit

We Shop.
You Drive.