Step 1: About You
Primary Insured
Current / Mailing Address
Where you live right now. If you are moving, enter your current address here - you will enter the new property address later.
Current Insurance
Claims History
Describe claims (dates, type, approximate amount)
Continue to Policy Selection
Step 3: Policy Details
Upload your current dec pages if you have them - we can pull most of what we need. Fill in anything else you know. Leave the rest blank and we will figure it out together.
Homeowners - Primary Residence Fill in what you know below. Leave anything blank you are not sure about - we will figure it out together. You can upload your dec page on the next step.
Current Home Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
Your current address is captured in Step 1. Enter the address of the home you are purchasing or moving to below.
Property Address The address of the home you want insured. If you are moving, this is the new property.
Street Address
Property Details Construction Select... Frame Masonry Fire Resistive Log Other
Roof Type Select... Asphalt Shingle Metal Tile Slate Wood Shake Flat/Built-Up Other
Heating Select... Forced Air Boiler Heat Pump Electric Baseboard Radiant Floor Wood / Pellet Other
Foundation Select... Basement (Finished) Basement (Unfinished) Crawlspace Slab Pier / Post
Garage Select... None Attached 1-car Attached 2-car Attached 3-car Detached Carport
Bedrooms / Bathrooms
Updates - When were these last updated? Approximate year is fine. Leave blank if original or not sure - we will work through it.
Reconstruction Cost This is not market value - it is what it would cost to rebuild your home from the ground up. If you do not know, leave blank and we will help estimate.
Preferred Deductible Select... $500 $1,000 $2,500 $5,000 $10,000 Not sure
Security Select... Monitored Alarm Local Alarm Cameras Only None
Property Features Pool Type Select... In-ground Above-ground
Fenced? Select... Yes No
Safety net enclosure? Select... Yes No
Describe structures and estimated values
List items and approximate values
Second Home / Vacation Home Fill in what you know. Skip what you do not have handy. You can upload your dec page on the next step.
Current Second Home Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
Property Address
Condo (HO-6) Fill in what you know. If you are not sure about HOA master policy coverage, we can help you find out. You can upload your dec page on the next step.
Current Condo Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
Unit Address
Liability Exposure Preferred Deductible Select... $500 $1,000 $2,500 $5,000 Not sure
Security Select... Building Secured Entry Monitored Alarm Cameras Only None
List items and approximate values
Renters Insurance (HO-4) Fill in what you know. Leave anything blank you are not sure about - we will figure it out together. You can upload your dec page on the next step.
Current Renters Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
Rental Address The address of the rental you want insured. If you are moving, this is the new place.
Street Address
Coverage Details Preferred Deductible Select... $500 $1,000 $2,500 Not sure
Liability Exposure List items and approximate values
Landlord / Rental Properties Tell us about each rental property you own. You can upload your dec pages on the next step.
Current Landlord Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
How many rental properties? Select... 1 2 3 4
Auto Driver license # for the primary insured carries across to your other vehicle policies (ATV, motorcycle, RV, boat). You can upload your dec page on the next step.
Current Auto Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
Policy-Wide Coverage Preferences These apply to all vehicles on the policy. If you are not sure, select "Not sure" and we will recommend.
Liability Limits Select... 50/100/50 100/300/100 250/500/100 $500,000 CSL $1,000,000 CSL Not sure - recommend for me UM/UIM will match these limits automatically
Comp / Collision Deductible Select... $250 $500 $1,000 $2,500 Not sure
OEM Parts Endorsement Select... Yes - use OEM parts on repairs No - aftermarket parts OK Not sure OEM = Original Equipment Manufacturer parts
Drivers List all household members age 15+ who drive, even if they have their own policy. We need this even with a dec page upload.
How many drivers? Select... 1 2 3 4 5 6
Driver 1 Date of Birth
Gender Select... Male Female Non-binary
Marital Status Select... Single Married Divorced Widowed
License Number
License State Select...
Years Licensed Select... Under 3 3-5 5-10 10+
Violations (past 3 years) Select... None 1 2 3+
At-fault Accidents (past 3 years) Select... None 1 2 3+
Driver 2 Date of Birth
Gender Select... Male Female Non-binary
Marital Status Select... Single Married Divorced Widowed
License Number
License State Select...
Years Licensed Select... Under 3 3-5 5-10 10+
Violations (past 3 years) Select... None 1 2 3+
At-fault Accidents (past 3 years) Select... None 1 2 3+
Driver 3 Date of Birth
Gender Select... Male Female Non-binary
Marital Status Select... Single Married Divorced Widowed
License Number
License State Select...
Years Licensed Select... Under 3 3-5 5-10 10+
Violations (past 3 years) Select... None 1 2 3+
At-fault Accidents (past 3 years) Select... None 1 2 3+
Driver 4 Date of Birth
Gender Select... Male Female Non-binary
Marital Status Select... Single Married Divorced Widowed
License Number
License State Select...
Years Licensed Select... Under 3 3-5 5-10 10+
Violations (past 3 years) Select... None 1 2 3+
At-fault Accidents (past 3 years) Select... None 1 2 3+
Driver 5 Date of Birth
Gender Select... Male Female Non-binary
Marital Status Select... Single Married Divorced Widowed
License Number
License State Select...
Years Licensed Select... Under 3 3-5 5-10 10+
Violations (past 3 years) Select... None 1 2 3+
At-fault Accidents (past 3 years) Select... None 1 2 3+
Driver 6 Date of Birth
Gender Select... Male Female Non-binary
Marital Status Select... Single Married Divorced Widowed
License Number
License State Select...
Years Licensed Select... Under 3 3-5 5-10 10+
Violations (past 3 years) Select... None 1 2 3+
At-fault Accidents (past 3 years) Select... None 1 2 3+
Vehicles Liability is automatic on every vehicle. Comp and collision are per-vehicle choices.
How many vehicles? Select... 1 2 3 4 5 6 7 8
Vehicle 1 Primary Use Select... Commute Pleasure Business
Annual Miles
Ownership Select... Owned Financed Leased
Garaging ZIP
Comprehensive Coverage Select... Yes No Covers theft, weather, fire, glass, animal damage
Collision Coverage Select... Yes No Covers damage from accidents with other vehicles or objects
Vehicle 2 Primary Use Select... Commute Pleasure Business
Annual Miles
Ownership Select... Owned Financed Leased
Garaging ZIP
Comprehensive Coverage Select... Yes No Covers theft, weather, fire, glass, animal damage
Collision Coverage Select... Yes No Covers damage from accidents with other vehicles or objects
Vehicle 3 Primary Use Select... Commute Pleasure Business
Annual Miles
Ownership Select... Owned Financed Leased
Garaging ZIP
Comprehensive Coverage Select... Yes No Covers theft, weather, fire, glass, animal damage
Collision Coverage Select... Yes No Covers damage from accidents with other vehicles or objects
Vehicle 4 Primary Use Select... Commute Pleasure Business
Annual Miles
Ownership Select... Owned Financed Leased
Garaging ZIP
Comprehensive Coverage Select... Yes No Covers theft, weather, fire, glass, animal damage
Collision Coverage Select... Yes No Covers damage from accidents with other vehicles or objects
Vehicle 5 Primary Use Select... Commute Pleasure Business
Annual Miles
Ownership Select... Owned Financed Leased
Garaging ZIP
Comprehensive Coverage Select... Yes No Covers theft, weather, fire, glass, animal damage
Collision Coverage Select... Yes No Covers damage from accidents with other vehicles or objects
Vehicle 6 Primary Use Select... Commute Pleasure Business
Annual Miles
Ownership Select... Owned Financed Leased
Garaging ZIP
Comprehensive Coverage Select... Yes No Covers theft, weather, fire, glass, animal damage
Collision Coverage Select... Yes No Covers damage from accidents with other vehicles or objects
Vehicle 7 Primary Use Select... Commute Pleasure Business
Annual Miles
Ownership Select... Owned Financed Leased
Garaging ZIP
Comprehensive Coverage Select... Yes No Covers theft, weather, fire, glass, animal damage
Collision Coverage Select... Yes No Covers damage from accidents with other vehicles or objects
Vehicle 8 Primary Use Select... Commute Pleasure Business
Annual Miles
Ownership Select... Owned Financed Leased
Garaging ZIP
Comprehensive Coverage Select... Yes No Covers theft, weather, fire, glass, animal damage
Collision Coverage Select... Yes No Covers damage from accidents with other vehicles or objects
Umbrella / Excess Liability You can upload your current umbrella dec page on the next step.
Current Umbrella Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
Desired Umbrella Limit Select... $1,000,000 $2,000,000 $3,000,000 $5,000,000 $10,000,000 Not sure - recommend for me
Check all underlying policies this umbrella should sit above:
Boat / Watercraft Tell us about each boat or watercraft.
Current Boat / Watercraft Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
Primary operator driver license - we need this for accurate watercraft rates. Enter once and it carries across all your vehicle policies.
How many boats? Select... 1 2 3
Boat 1 Estimated Value ($)
Has Trailer? Select... Yes No
Storage Select... Marina (In Water) Marina (Dry Storage) Home / Driveway On Trailer
Boat 2 Estimated Value ($)
Has Trailer? Select... Yes No
Storage Select... Marina (In Water) Marina (Dry Storage) Home / Driveway On Trailer
Boat 3 Estimated Value ($)
Has Trailer? Select... Yes No
Storage Select... Marina (In Water) Marina (Dry Storage) Home / Driveway On Trailer
ATV / OHV Current ATV / OHV Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
Primary operator driver license - we need this for accurate ATV / OHV rates. Enter once and it carries across all your vehicle policies.
How many atv / ohvs? Select... 1 2 3 4
ATV / OHV 1 Type Select... ATV UTV / Side-by-Side Dirt Bike
Use Select... Recreational Ranch / Farm Work Both
ATV / OHV 2 Type Select... ATV UTV / Side-by-Side Dirt Bike
Use Select... Recreational Ranch / Farm Work Both
ATV / OHV 3 Type Select... ATV UTV / Side-by-Side Dirt Bike
Use Select... Recreational Ranch / Farm Work Both
ATV / OHV 4 Type Select... ATV UTV / Side-by-Side Dirt Bike
Use Select... Recreational Ranch / Farm Work Both
RV / Motorhome Current RV / Motorhome Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
Primary operator driver license - we need this for accurate RV rates. Enter once and it carries across all your vehicle policies.
How many rvs? Select... 1 2
RV 1 Full-time residence? Select... Yes No
RV 2 Full-time residence? Select... Yes No
Motorcycle Current Motorcycle Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
Primary operator driver license - we need this for accurate motorcycle rates. Enter once and it carries across all your vehicle policies.
How many motorcycles? Select... 1 2 3
Pet Insurance Tell us about your pets. We will find the best coverage options.
Current Pet Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
How many pets? Select... 1 2 3 4
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Step 4: Review and Submit
Policy Documents
For any policy you have today, check the box and upload your current dec page. We can pull most of what we need from it.
No policies selected on Step 2 - go back to add some.
Additional Documents
Anything else that helps us quote - driver lists, equipment schedules, appraisals.
Anything else we should know?
Preferred Agent (optional) No preference Kirk Chester Justin Peterson Justin Acheson Samantha Desoro Syrena Ziegler Jessica Fugate Tanisha Loveland Other / Referral
I authorize Grit Insurance Group to use this information to obtain insurance quotes on my behalf. I understand this does not constitute the purchase of insurance and that all coverage is subject to underwriting approval.
By submitting this application, you confirm that the information provided is accurate to the best of your knowledge. Grit Insurance Group will use this information solely for the purpose of obtaining insurance quotes. This application does not bind coverage. All policies are subject to underwriting review and approval by the issuing carrier.
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