Select Insurance Quote

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Let’s Get Started! Tell us a little about yourself and your insurance needs. One of our expert agents will get you rolling with an instant quote so that you can return your focus back to where it belongs – on the road ahead. Don’t feel like filling out the form? Call us now at (855) 438-7353 to get your insurance in 20 minutes!!
What kind of quote are you looking for?*
State*

Personal Information
First Name*
Last Name*
Address*
Street Address Address Line 2 City ZIP / Postal Code
Date of Birth*
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Contact Information & Consent
Email*
Phone*
Best way to contact you?*
Contact Consent*
I agree to allow Select Insurance Team contact me with my quote information
The Select Insurance Team handles your information carefully. We will be contacting you via your preferred method shortly.

Vehicle Information
If you own, lease or make payments on a vehicle in your name, then you need car insurance.
Do you need to insure a car?*
Make & Model
Make and model of the car.
Year
Year of the car.
VIN #
Vehicle identification number of the car.

Insurance Information
Are you currently insured?
Current Insurance Company
How long have you been with this company?

Other Information
How soon are you looking for coverage to start?*
Insurance pricing changes. To ensure an accurate quote, please estimate the time frame needed before purchasing an insurance plan.
Driver's License Verification
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Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB, Max. files: 2.
Upload a photo of the front of your driver’s license. Only include back of the license IF you have driving restrictions listed.
Case Number Associated with Risk
In most cases, this is a 9-digit number without letters issued by the court notifying you that you need special insurance coverage.
I have a DUI/DWI and I need an ignition interlock device – have Intoxalock contact me with prices and discounts.
Do you own a home?
This information will be used for quoting insurance products and services. Additionally, Select Insurance Group may share your information with affiliated companies and our third-party service providers who may use automated technology and/or pre-recorded means to call, text and email you in order to gain access to products and services to better assist you. By submitting this form, you agree to be contacted by a Select Insurance Group Licensed Agent, or affiliate. Select Insurance may share your information in any instance we are required to by law.*
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Date Submitted
MM slash DD slash YYYY
Truth & Liability Agreement*
I agree that all information submitted here is both truthful and intended to be used to generate an exclusive quote from Select Insurance Team
You are submitting information for yourself, or a family member who needs to obtain insurance under a special category.
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Contact Information & Consent

Vehicle Information

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