New Quote Request

Thank you for contacting Brightway Insurance, The Lunte Family Agency. In order to provide you with the most accurate quote possible, please complete the form below. We're here to answer any questions you have along the way.

Home?

Rental property?

Car?

Motorcycle?

Recreational vehicle (RV)?

General Information:

Name & Birthdates of all household members

Home Address

Mailing Address, if different

Social Security Number

Highest Level of Education (you & spouse)

Occupation (you & spouse)

Any convictions of a felony?

Homeowners Information:

Effective Date of Current Policy

Number of Years at Current Address

If less than 5 years, please provide prior address

Any residents not current family members?

Number of children in home

Number of acres if not in a neighborhood

Any dogs in the home?

If yes, list number and breed(s).

House features:

Swimming Pool

Trampoline

Central Fire and/or Burglar Alarm

Any current construction or renovation?

Please describe any losses during the past 5 years.

Roof - Most recent replacement year

Plumbing - Most recent replacement year

Electrical - Most recent replacement year

HVAC - Most recent replacement year

Mortgage Information

Current Homeowners Insurance Premium (estimated)

Rental Property Information:

Effective Date of Current Policy

Rental Property Address

Currently Tenant Occupied

Term of lease (monthly, annually)

Any participation in short term rentals (Airbnb)

Any dogs kept by tenant

If yes, list number and breed(s).

Central Fire and/or Burglar Alarm

Any current construction or renovation?

Please describe any losses during the past 5 years.

Roof - Most recent replacement year

Plumbing - Most recent replacement year

Electrical - Most recent replacement year

HVAC - Most recent replacement year

Current Insurance Premium (estimated)

Auto Information:

Current Effective Date of Policy

Is current policy 6 or 12 months?

Current Liability Limits (eg. $100,000 per person, $300,000 per accident)

Current Comprehensive Deductible Current Collision Deductible

Driver License Number of All Drivers

Vehicle Identification Number of All Vehicles (picture of your current Auto ID Card works)

Indication if each vehicle was bought new or used

Any Student Drivers in the Home?

If yes, is their GPA 3.0 or Higher?

Did they attend Drivers Education Program?

Do they go to school over 100 miles away from home address?

Primary Use for each vehicle? (eg. Pleasure, commuting)

Estimated miles driven per year per vehicle

Any driving done for ride sharing services? (eg. UBER, Lyft)

Information on any moving violations in last 5 years.

Information on any accidents in last 5 years.

Information on any comprehensive losses in last 5 years, (eg. Hail)

Lease or Lienholder Information for each vehicle

Current Auto Premium (estimated)

Motocycle Information:

Current Effective Date of Policy

Is current policy 6 or 12 months?

Current Liability Limits (eg. $100,000 per person, $300,000 per accident)

Driver License Number of All Drivers

Vehicle Identification Number of All Vehicles (picture of your current Auto ID Card works)

Any after factory equipment installed? If Yes, estimated value.

Do you partake in special processions in connection with your business? (e.g. parades, funerals)

Do you have the motrocycle endorsement on your license?

Have you partipcated in a Operators Safety Course and/or Alcohol & Drug Awareness Course in the last 5 years. If so, date completed?

Do you belong in a motorcycle riding group? If so, name of group?

Information on any accidents in last 5 years.

Current Auto Premium (estimated)

Recreational Vehicle:

Current Effective Date of Policy

Driver License Number of All Drivers

Motorhome or Travel Trailer?

Manufacture, Model, and Model Year

Vehicle Identification Number of All Vehicles (picture of your current Auto ID Card works)

Length

Estimated Purchase Date

Estimated Purchase Price

Primary Use

Estimated miles driven per year per vehicle

Is RV currently located in a park?

Estimated amount of personal property inside RV?

Information on any comprehensive losses in last 5 years, (eg. Hail)

Current RV Premium (estimated)