Insurance Quotes in Palm Harbor FL | Reliant Insurance Services

What type of quote can we provide for you?

Step 1 of 13

What type of insurance can we quote for you? Click all that apply.(Required)

Auto

Home/Townhome

Condo

Builders Risk (Coverage During Construction)

Umbrella

Motorcycle/Slingshot/ATV

Golf Cart

Boat

Renters

New purchase or already own the property?(Required)

New Purchase

Already Own

Is the property currently insured?(Required)

Yes - I have maintained my coverage.

No - I have lapsed (Less than 30 Days)

No - I have lapsed (More than 30 Days)

Maybe - My lender force placed insurance

How is / will the property be occupied? CLICK ALL THAT APPLY(Required)

Primary Residence

Secondary Residence

Rented

What is the SHORTEST amount of time it will be rented?(Required)

Annual Rental (Monthly Payments)

Monthly Rental (Short-Term)

Weekly Rental (Short-Term)

Nightly Rental (Short-Term)

When will the property be occupied by owner or tenant?(Required)

0-15 days after closing?

16-30 days after closing?

30+ Days after closing?

Plans for the property over the next 12 months.(Required)

Please describe the types of renovations planned:(Required)

How is / will the property be titled?(Required)

Personal Name(s)

Trust

LLC

Corporation

In Probate

Entity Name of: Trust, LLC, Corp or Probate (if applicable)

Name(Required)

First Last

Mobile Phone(Required)

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Driver's License(Required)

Highest Level of Education(Required)

Highschool Diploma / GED

Some College

Associate Degree

Bachelor's Degree

Masters / Doctorate / Law Degree

Occupation(Required)

Is there another person who will have an insurable interest in the property / vehicle being insured?(Required)

Yes

Co-Applicant Name(Required)

First Last

Co-Applicant Mobile Phone (Must be different from Applicant)(Required)

Co-Applicant Email (Must be different from Applicant)(Required)

Co-Applicant Date of Birth(Required)

MM slash DD slash YYYY

Driver's License(Required)

Co-Applicant Occupation(Required)

Highest Level of Education(Required)

Highschool Diploma / GED

Some College

Associate Degree

Bachelor's Degree

Masters / Doctorate / Law Degree

Referred By(Required)

Realtor

Lender

You are a Current Client

Friend / Family

Nextdoor

Facebook

School (County) Discount Page

Internet

So that we can thank the person who referred you, can you tell us their name?(Required)

Which County School System?(Required)

Who is the primary point of contact?(Required)

Current Address (No PO Boxes)(Required)

Street Address Address Line 2 City State ZIP Code

Address of Property Being Purchased(Required)

Same as current address

Street Address Address Line 2 City State ZIP Code

Would you like to add a different mailing address?(Required)

Yes

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Is the home in a Gated Community?(Required)

Yes, Passkey Gate Entrance

Yes, 24 Hour Manned Gate

Do you or will you have a Monitored Burglar/Fire Alarm?(Required)

Yes

Are there any Dog(s) on Property?(Required)

Yes

Dog Breeds(Required)

If mixed please indicate type of mix.

Any bite history or security training?(Required)

Yes

Do you have or will you have a Trampoline on the Property?(Required)

Yes

Are you aware of any previous settlement or sinkhole issues on the property?(Required)

Yes

Have you had OR reported any home or renter's insurance claims in the past 5 years?(Required)

Yes

Approximate Date of Loss(Required)

MM slash DD slash YYYY

Approximate Amount(Required)

Please describe the loss as best you can remember.(Required)

Please add any additional notes that you think we should know:

Auto Information

Total Drivers in Home(Required)

Total Vehicles in Home(Required)

Driver #2

Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Driver's License(Required)

Occupation(Required)

Relationship to Primary Applicant(Required)

Spouse

Child

Parent

Other

Does this driver have a primary vehicle?(Required)

Yes

Driver #3

Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Driver's License(Required)

Occupation(Required)

Relationship to Primary Applicant(Required)

Spouse

Child

Parent

Other

Does this driver have a primary vehicle?(Required)

Yes

Driver #4

Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Driver's License(Required)

Occupation(Required)

Relationship to Primary Applicant(Required)

Spouse

Child

Parent

Other

Does this driver have a primary vehicle?(Required)

Yes

Driver #5

Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Driver's License(Required)

Occupation(Required)

Relationship to Primary Applicant(Required)

Spouse

Child

Parent

Other

Does this driver have a primary vehicle?(Required)

Yes

Vehicle #1

VIN

Vehicle Year(Required)

Make(Required)

Model(Required)

Business Use(Required)

Yes

Type of Business(Required)

Rideshare or Delivery?(Required)

Yes

Vehicle #2

VIN

Vehicle Year(Required)

Vehicle Make(Required)

Vehicle Model(Required)

Business Use(Required)

Yes

Type of Business(Required)

Rideshare or Delivery(Required)

Yes

Vehicle #3

VIN

Vehicle Year(Required)

Vehicle Make(Required)

Vehicle Model(Required)

Business Use(Required)

Yes

Type of Business(Required)

Rideshare or Delivery(Required)

Yes

Vehicle #4

VIN

Vehicle Year(Required)

Vehicle Make(Required)

Vehicle Model(Required)

Business Use(Required)

Yes

Type of Business(Required)

Rideshare or Delivery(Required)

Yes

Vehicle #5

VIN

Vehicle Year(Required)

Vehicle Make(Required)

Vehicle Model(Required)

Business Use(Required)

Yes

Type of Business(Required)

Rideshare or Delivery(Required)

Yes

Investment Property

Address(Required)

Street Address Address Line 2 City State ZIP Code

Property Status(Required)

Currently Occupied with Tenants

Listed For Sale - No Occupants

Listed For Rent - No Occupants

Undergoing Renovations - Vacant

Motorcycle/Slingshot/ATV

Name of Primary Driver(Required)

First Last

Vehicle Type(Required)

Motorcycle

Slingshot

ATV

Is Vehicle Used for Racing?(Required)

Yes

Current Motorcycle License(Required)

Yes

Has Driver Completed Safety Course?(Required)

Yes

Year(Required)

Make(Required)

Model(Required)

Umbrella

List information for all persons living in the household of driving age.

For each driver include - Name, Date of Birth, DL Number, Accidents and/or tickets in last 5 years. Skip this if all drivers are already listed in the auto section of this form.

Should any drivers be EXLUDED?

Hidden

In order to purchase an umbrella liability policy you must have auto liability limits of at least $250,000/$500,000/$250,000 and home/renters liability of at least $300,000.

I understand that if the current liability limits on my auto and home/renters policies do not meet those minimums I will not be eligible to purchase an umbrella liability policy.

How many owner occupied homes do you own?(Required)

How many rental properties do you own?(Required)

How many home/renters claims have you made in the last 5 years?(Required)

How many vehicles do you own?(Required)

How many auto claims have you made in the last 5 years?(Required)

Any drivers on your auto policy have an at-fault accident in the last 5 years?(Required)

Yes

Do you own any motor homes?(Required)

Yes

Do you own any vacant land?(Required)

Yes

How many acres?

Do you own any of the following items?(Required)

Boat/Yacht

Motorcycle

ATV

Golf Cart

Vacant Land

Business

None of the Above

Please provide the current insurance declarations pages for all applicable exposures (auto, home, watercraft, motorhome, motorcycle, etc.)

Max. file size: 98 MB.

Boat Information

Boat Year

Boat Make

Boat Model

Motor Type(Required)

Inboard

Outboard

How many motors?(Required)

Motor #1 Year(Required)

Motor #1 Make(Required)

Motor #1 Model

Motor #2 Model(Required)

Motor #2 Make(Required)

Motor #2 Year

Motor #3 Year(Required)

Motor #3 Make(Required)

Motor #3 Model

What is the value of the boat and motors?

Do you own a boat trailer?(Required)

Yes

Trailer Year(Required)

Trailer Make(Required)

Trailer Model(Required)

What is the value of the trailer?

Hull Number

Top Speed (MPH)(Required)

Boat Length(Required)

Boat is used for racing?(Required)

Yes

Where is boat stored when not in use?(Required)

Primary Residence

Marina - Slip

Marina - Dry Stack

Storage Facility - On Trailer

Other

Where is boat stored?

Zip code where boat is stored

Please enter a number less than or equal to 99999.

Have you completed a boaters safety course in the last 3 years?

Yes

How many years of boating experience do you have?

Golf Cart

Year(Required)

Make(Required)

Model(Required)

Primary Use

Within Community

Golfing

Public Roads (Requires Registration & Tag)

Fuel Type

Electric

Gas

Recreational Vehicle

RV Type

5th Wheel

Motorcoach

Other

Year(Required)

Make(Required)

Model(Required)

Number

Current Address (No PO Boxes)(Required)

Street Address Address Line 2 City State ZIP Code

Is this residence student housing?

If it is an apartment, please list the square feet of the unit.

Number of Permanent Residents

Value of all personal property stored at address

What Floor do you live on?

Please upload any insurance documents and/or inspection reports.

Drop files here or

Max. file size: 98 MB, Max. files: 5.

Consent(Required)

Reliant Insurance Services may contact me via phone call, email and text message.