DSB Insurance — Quote Request DSB Insurance Quote Request — answer what you can, we'll fill in the rest together Step 1 What can we quote for you? Pick everything that applies — the form will only show the questions for what you select. Takes about 5–10 min depending on what you select. Get started → Step 2 — About you The basics So we can pull a quote and reach you. Full legal name Date of birth SSN (needed for an accurate quote — optional here) Phone Email Mailing address City State ZIP Marital status Single Married Domestic partner Divorced Widowed Occupation Years in occupation Spouse / partner full name Spouse DOB Spouse occupation How did you hear about DSB Insurance? ← Back Next → Step 3 — What matters to you Tell us what matters to you These four answers help us find you the right fit, not just the cheapest sticker price. Why are you looking for insurance elsewhere? Other than price, what's most important to you in an insurance agency? What is something you were unhappy with at your current agency? What is something you like or are happy with at your current agency? ← Back Next → Auto Your auto Tell us about your current coverage, drivers, and vehicles. Current auto coverage Current carrier How long with them? Policy expiration Current premium Any losses or claims in the past 5 years? Is it OK if we run the reports needed for an accurate quote? (CLUE / MVR / credit / NCF) Yes No Drivers in the household Add everyone with a license living at the address — even occasional drivers. ＋ Add another driver Any good-student discounts? (Who?) Do you own or rent your home? Own Rent Liability & personal limits Pick the limits you want quoted — we'll show the cost difference. Bodily Injury (BI) 25/50 50/100 100/300 250/500 300/300 500/500 Property Damage (PD) 25 50 100 250 300 Medical Payments 1,000 5,000 10,000 Uninsured Motorist (UM) 25/50 50/100 100/300 250/500 300/300 500/500 Vehicles ＋ Add another vehicle Optional coverage add-ons ← Back Next → Home Your home Tell us about the property and current coverage. The property Property address Date of purchase Purchase price Mortgage amount Years financed Fire department Miles to fire dept. Construction & layout Year built # of stories Construction Manufactured Frame Brick Log Other Acreage Bedrooms # of baths Eat-in kitchen? Yes No Basement None Partial — Unfinished Partial — Finished Full — Unfinished Full — Finished Garage None Attached Detached # of cars (garage) Central air? Yes No Other rooms / outbuildings Present coverage (if you have a policy) Dwelling Other Structures Personal Property Loss of Use Liability Deductible Current carrier Expiration Any losses or claims in the past 5 years? Is it OK if we run the reports needed (CLUE / NCF / credit)? Yes No Underwriting questions Foreclosure / repossession / bankruptcy in the last 5 years? Yes No Pool or trampoline on property? Swimming pool Trampoline Fenced Pets — dogs? Breed? Bite history? Any business conducted on the premises? Recreational vehicles (4wheelers, dirt bikes, snowmobiles, boats)? Smokers in household? Smoker Non-smoker Roof, wiring, heating, plumbing Roof type Roof age Wiring Circuit breakers Fuses Amps 60 100 200 Other Heating type Furnace age Alternative heat Woodstove Fireplace Kerosene heater Other Plumbing — any updates? Optional coverage add-ons ← Back Next → Life Life insurance A few health and financial basics so we can match you to the right coverage. Health snapshot — you Gender Smoker? Yes No Height / Weight Known health conditions and/or medications Health snapshot — spouse / partner Gender Smoker? Yes No Height / Weight Known health conditions and/or medications Financial picture Do you own a home? Yes No Mortgage balance Years financed Your annual income Spouse annual income Other significant debts Children & dependents ＋ Add a child / dependent Coverage type & amount Pick everything you'd like priced — we can compare a couple side by side. Coverage amount you have in mind (you) Spouse Beneficiary (you) Beneficiary (spouse) Existing life insurance Do you currently have life insurance? Yes No Carrier Face amount Type (term / whole / UL) Premium Through employer? Yes No ← Back Next → Motorcycle Your motorcycle Bike(s), riding profile, and the coverages you'd like priced. Current motorcycle coverage Current carrier Expiration Current premium Years with carrier Rider profile Years of riding experience Endorsement on license? Yes No Completed a safety course (MSF or equivalent)? Yes No Any riding accidents/violations in past 5 years? Bike(s) to quote ＋ Add another bike Liability & coverage limits Bodily Injury 25/50 50/100 100/300 250/500 Property Damage 50 100 250 Comp deductible 100 250 500 1000 Coll deductible 250 500 1000 Optional coverage add-ons ← Back Next → RV Your RV Unit details, how you use it, and coverage options. Current RV coverage Current carrier Expiration Current premium Use Recreational Full-time Seasonal Rented out RV(s) to quote ＋ Add another unit Liability & coverage limits Bodily Injury 50/100 100/300 250/500 500/500 Property Damage 50 100 250 300 Comp deductible 250 500 1000 2500 Coll deductible 250 500 1000 2500 Optional coverage add-ons ← Back Next → Boat Your boat / watercraft Vessel(s), how you use them, and coverage options. Current boat coverage Current carrier Expiration Current premium Years boating Any boating accidents / claims / violations in past 5 years? Vessel(s) to quote ＋ Add another vessel Use & operators Primary use Pleasure Charter / Rental Race Commercial Cruising waters Inland lake / river Coastal Great Lakes Ocean / Offshore Storage Marina — wet slip Marina — dry stack Trailer at home Mooring Storage / lay-up months Liability & hull limits Liability limit 100,000 300,000 500,000 1,000,000 Medical Payments 1,000 5,000 10,000 25,000 Hull deductible 250 500 1000 2500 Hull valuation Agreed Value Actual Cash Value Optional coverage add-ons ← Back Next → Last step Review & send When you click Send, we'll: Generate a PDF copy of your responses (downloads automatically). Open your email with a pre-filled message to jasonb@dsbinsurance.com — just hit send and attach the PDF if you'd like. Anything else you'd like us to know? Best way & time to reach you? I authorize DSB Insurance to contact me about this quote and to run any reports needed for an accurate quote (CLUE / MVR / credit / NCF, as applicable). ← Back Send my quote request ✅ Thanks — we got it! Your PDF copy has been downloaded. Your email client should also have opened with a pre-filled message — just hit send. Didn't see anything happen? Click below. Re-download PDF Re-open email
