Step 1: Your Household
Primary Contact
Marital Status Select... Single Married Divorced Widowed Domestic Partner
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
What brings you to Grit? Select... Rate increase Concerned about coverage gaps Life change (new home, inheritance, business sale) Current carrier non-renewing First time shopping private client insurance Referred by advisor or friend Other
Household Profile
We ask these ranges to match you with the right carrier program. Private client carriers have eligibility thresholds. Skip these if you prefer to discuss on a call.
Household Income Range Select... $250K - $500K $500K - $1M $1M - $2M $2M - $5M $5M+ Prefer not to say
Total Property Value (all properties) Select... $1M - $2M $2M - $5M $5M - $10M $10M - $25M $25M+ Prefer not to say
Claims History
Describe claims (dates, type, approximate amount)
Step 3: Details
Upload current dec pages if you have them. Share what you can below - your advisor will walk through the rest with you.
Additional Properties Tell us about each additional property. You can upload your dec pages on the next step.
Current Additional Properties Coverage Have a dec page? You can upload it on Step 4 - leave these blank if you would rather upload.
How many additional properties? Select... 1 2 3 4
Auto & Collector Vehicles Driver license # for the primary insured carries across to your watercraft policy. 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... 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... $500 $1,000 $2,500 $5,000 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. We need this even with a dec page upload.
How many drivers? Select... 1 2 3 4 5 6
Driver 1 Violations (past 5 years) Select... None 1 2 3+
At-fault Accidents (past 5 years) Select... None 1 2 3+
Driver 2 Violations (past 5 years) Select... None 1 2 3+
At-fault Accidents (past 5 years) Select... None 1 2 3+
Driver 3 Violations (past 5 years) Select... None 1 2 3+
At-fault Accidents (past 5 years) Select... None 1 2 3+
Driver 4 Violations (past 5 years) Select... None 1 2 3+
At-fault Accidents (past 5 years) Select... None 1 2 3+
Driver 5 Violations (past 5 years) Select... None 1 2 3+
At-fault Accidents (past 5 years) Select... None 1 2 3+
Driver 6 Violations (past 5 years) Select... None 1 2 3+
At-fault Accidents (past 5 years) Select... None 1 2 3+
Daily Driver Vehicles Standard daily-use vehicles. Comp and collision choices are per-vehicle. Liability is automatic on every vehicle.
How many daily driver vehicles? Select... 1 2 3 4 5 6
Vehicle 1 Primary Use Select... Commute Pleasure Business
Annual Miles
Ownership Select... Owned Financed Leased
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
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
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
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
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
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
Collector & Exotic Vehicles Classic, exotic, or high-value vehicles requiring agreed value coverage.
How many collector / exotic vehicles? Select... 1 2 3 4 5 6
Collector Vehicle 1 Condition Select... Original / Unrestored Restored Modified / Custom Daily Driver (Exotic)
Used for shows or events? Select... Yes No
Collector Vehicle 2 Condition Select... Original / Unrestored Restored Modified / Custom Daily Driver (Exotic)
Used for shows or events? Select... Yes No
Collector Vehicle 3 Condition Select... Original / Unrestored Restored Modified / Custom Daily Driver (Exotic)
Used for shows or events? Select... Yes No
Collector Vehicle 4 Condition Select... Original / Unrestored Restored Modified / Custom Daily Driver (Exotic)
Used for shows or events? Select... Yes No
Collector Vehicle 5 Condition Select... Original / Unrestored Restored Modified / Custom Daily Driver (Exotic)
Used for shows or events? Select... Yes No
Collector Vehicle 6 Condition Select... Original / Unrestored Restored Modified / Custom Daily Driver (Exotic)
Used for shows or events? Select... Yes No
Watercraft Tell us about each vessel. You can upload your dec page on the next step.
Current 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 vessels? Select... 1 2 3
Vessel 1 Captain / Crew? Select... Owner Operated Hired Captain Full Crew
Storage Select... Marina (In Water) Marina (Dry Storage) Home Trailer
Navigation Area
Vessel 2 Captain / Crew? Select... Owner Operated Hired Captain Full Crew
Storage Select... Marina (In Water) Marina (Dry Storage) Home Trailer
Navigation Area
Vessel 3 Captain / Crew? Select... Owner Operated Hired Captain Full Crew
Storage Select... Marina (In Water) Marina (Dry Storage) Home Trailer
Navigation Area
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... $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000+ Not sure - recommend for me
Exposure Profile These questions help us size the right umbrella for your situation.
Serve on any boards? (nonprofit, corporate, HOA) Select... Yes No
Public figure or high-profile occupation? Select... Yes No
Own a business? Select... Yes No
Social media presence Select... Minimal Moderate Significant / Public
Domestic Staff If you employ household staff, they may need workers compensation coverage.
Cyber & Identity Protection High-net-worth households are increasingly targeted. Most private client carriers include this or offer it as an endorsement.
Online banking / investment accounts? Select... Yes No
Smart home devices? (cameras, locks, thermostats) Select... Yes No
Previous identity theft or cyber incident? Select... Yes No
Social media presence Select... Minimal / Private Moderate Significant / Public
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Step 4: Review and Submit
Policy Documents
For any coverage you have today, check the box and upload your current dec page or appraisal. We pull most of what we need from it.
No coverage selected on Step 2 - go back to add some.
Additional Documents
Anything else that helps - driver lists, collection inventories, prior loss reports.
Anything else we should know?
Preferred Advisor (optional) No preference 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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