Skip to the content
Call:
(412) 207-9047
Google Maps Logo (opens in new tab)
Yelp Logo (opens in new tab)
Facebook Logo (opens in new tab)
X Logo (opens in new tab)
LinkedIn Logo (opens in new tab)
Instagram Logo (opens in new tab)
Schedule An Appointment
(opens in new tab)
Home Page
Services
Auto, Home, and Personal Insurance
Auto Insurance
Homeowners Insurance
Renters Insurance
Motorcycle Insurance
Boat & Marine Insurance
- View All Personal
Business Insurance
Business Owners Package Insurance
Commercial Auto Insurance
Commercial Property Insurance
General Liability Insurance
Workers’ Compensation Insurance
- View All Business
Life Insurance
Fixed Annuities
Final Expense Insurance
Individual Life Insurance
Mortgage Protection Insurance
- View All Life
Group Benefits
Group Disability Insurance
Group Long-Term Care
- View All Group Benefits
Notary Services
Homeowners Insurance Quotes
Auto Insurance Quotes
Auto & Home Insurance Quotes
Commercial Insurance Quotes
Commercial Property Insurance Quotes
Classic Car / Antique Car Quotes
About
Sharp Insurance Podcast
Meet Our Staff
Customer Reviews
Insurance Companies
Insurance Blog
Support
Online Billing & Payments
File A Claim
Auto ID Card Request
Certificate of Insurance Request
Policy Change Request
Annual Insurance Checklist
Insurance Resources
Refer a Friend
Contact
Pittsburgh Office
Secure Contact Form
Get Quote
Home
>
Home & Auto Insurance Quote
Home & Auto Insurance Quote
Your Information
Name
Phone
Texting
*
I consent to receive text messages at the provided number
I opt out of text messages
Email
Date of Birth
MM slash DD slash YYYY
Driver's License State & Number
Marital Status
Do you do any TNC/Rideshare (if so which company Lyft, Uber, Doordash)
Who are you currently insured with?
Occupation
When do you need the policy to start?
How did you hear about us?
Second Insured Information
Name
Occupation
Date of Birth
MM slash DD slash YYYY
Driver's License State & Number
Home Information
Current Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Please add your previous address if you lived at your current address for less than 3 years or new purchase
Street Address
City
State / Province / Region
ZIP / Postal Code
Type of Home
Primary/Secondary Home
Investment Property Rented to Others
If Purchase provide the following:
Purchase Price
Expected occupancy date
Would you like coverage for underground service lines
Yes
No
If yes, 10,000 or 20,000 or max allowed?
Would you like Water back up coverage
Yes
No
If yes, please choose dwelling amount
$5,000
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
$100,000
Would you like equipment breakdown?
Yes
No
Do you insure any other items such as jewelry, furs, gold or other items listed on your policy.
Any Planned Renovations?
Yes
No
If Yes, please explain what type of work and an estimated amount of the cost.
Year Roof was Replaced?
Year Central Heating (furnace) was Replaced?
Any dogs owned by the insured and/or kept at the insured location(s)?
Yes
No
Select one of these breeds:
Akita( include hybrid/mixes)
American Staffordshire Terrier ( include hybrid/mixes)
Bullmastiff ( include hybrid/mixes)
Chow Chow ( include hybrid/mixes)
Doberman Pincher ( include hybrid/mixes)
German Shepherd ( include hybrid/mixes)
Pit Bull ( include hybrid/mixes)
Presa Canario ( include hybrid/mixes)
Rottweiler ( include hybrid/mixes)
Wolf Hybrid ( include hybrid/mixes)
Other Breed
Other Breed
Age of the dog
How long have you owned the dog?
Do you own a fenced yard?
Yes
No
Does the dog have any bite history or history of aggressive behavior?
Yes
No
Does the dog have any formal training including puppy training?
Yes
No
Pool, trampoline, hot tub, diving board and/or slide?
Do you have a home security system
Local (only you are notified)
Central (police and/or Fire are notified)
Do you have any solar panels on your home? If so how many panels?
Do you have a sump pump? If so is there a power back up battery or supplied electric?
Is your basement finished? If so how much (50% 100%)?
Do you have a wood burning stove? If so, what model, was it professionally installed, and how often is your chimney cleaned?
Do you have any additional structures on your property? Example: Sheds, decks, detached garages
Have you had any home claims in the last 5 years?
Is the property insured currently?
Yes
No
Who is the current insurer?
Additional Drivers
Add Driver
Full Name
D.O.B.
Gender
License State
License Number
Vehicles
Add Vehicle
Make/Model
Annual Mi. Driven
Usage - business/pleasure
Assigned Driver
Vehicle VIN
VIN
Have you had continuous insurance for at least 6 months?
Yes
No
Have you had any accidents in the last 5 years?
Yes
No
If Yes, list Current Insurance Company
Physical Damage (Full Coverage)
Yes
No
Do we insure all owned autos?
Yes
No
Additional Comments
Upload Files
Drop files here or
Select files
Max. file size: 59 MB.
Email
This field is for validation purposes and should be left unchanged.
Δ
