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Main
Insurance
Home & Auto Insurance
Auto Insurance
Business Insurance
Company Profile
Contact
Home & Auto Insurance From Trusted Providers
Your home is, well, it’s your home. Your castle. Your sanctuary. The place where you can be you. The thought of something happening to it is unbearable. When you submit the information requested below to Advantage Insurance Group, we will obtain quotes from several top companies to find the best protection at the best price. Many insurance companies in Oklahoma will not write a policy for your home if they do not also write the policy for your automobiles, which is why we request this information as well. On the plus side, they do offer discounts for writing both policies.
Applicant Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Preferred Phone Number
*
Email
Preferred Method of Contact
Select method
Phone
Email
Applicant Date of Birth
*
Applicant Social Security Number
*
Applicant Driver Licence Number
*
Application Occupation
*
Spouse Name
First
Last
Spouse Date of Birth
Spouse Social Security
Spouse Driver License Number
Spouse Occupation
Value of Home
(if you are requesting a renter's policy, skip this field)
Value of Contents
(if you are requesting a Homeowner's policy, skip this field)
Square Footage of Home
*
Year Built
*
Year wiring was updated
Year Plumbing Was Updated
Year Heating Unit Was Updated
Number of Stories
Construction Type
*
Select type
Frame
Brick
Brick veneer
Wood siding
Metal siding
Mobile Home
Other
Year Roof Installed
*
Type of Roof
Select type
Asphalt shingle
Metal
Clay tile
Wood shingle
Flat (tar)
Other
Number of Bathrooms
Select number
1
2
3
4
5 or more
Home Foundation Type
*
Select type
Slab
Basement
Crawl space
Other
Is Your Home Within 1,000 Feet of a Working Fire Hydrant?
*
Yes
No
How Many Miles From Your Home to the Nearest Fire Station?
*
Do You Having a Swimming Pool?
*
No
Yes, and it's fenced in
Yes, and there is no fence
Do You Have a Trampoline?
*
Yes
No
Do You Have a Fireplace?
No
Yes, brick
Yes, metal
Type of Heating Unit
Select type
Gas
Propane
Electric
Floor heater
Other
Garage Size and Type
Select size and type
1 car attached
2 car attached
3 car attached
1 car detached
2 car detached
3 car detached
Carport only
No garage
Alarm System
Choose answer
None
Monitored
Local alert only
Dogs
If you have dogs, please list number of dogs and their breed.
Home Business
If you run any sort of business from your home, please list it here in detail.
Claims
Please list any claims you have had over the past 5 years. Dates, amount paid, type of loss.
Current insurance provider
Expiration date of current policy
Years with current insurance provider
less than 1
1-2
2-3
3-4
4-5
5+
Scheduled Valuables
Please list any scheduled valuables you would like quoted on the policy or any other information you feel we should know. Please list a value for each item listed.
Are You Purchasing This Home?
Yes
No
If This Is a New Purchase, Pleas List Your Current Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darrussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Please list your mortgagee information, including mailing address
Additional Household Drivers
Please list name, SS#, DOB, and DL# for any household driver other than applicant & spouse. ALL DRIVERS WHO LIVE IN YOUR HOUSEHOLD MUST BE LISTED!
Year, Make, Model of Vehicle 1
VIN Number for Vehicle 1
This is necessary for an accurate quote
Driver of Vehicle 1
Type of Coverage For Vehicle 1
Select deductible
No coverage/liability only
$250 deductible
$500 deductible
$1,000 deductible
Comprehensive/Collision coverage with deductible for Vehicle 1?
Year, Make, Model of Vehicle 2
VIN Number for Vehicle 2
Driver of Vehicle 2
Type of Coverage For Vehicle 2
Select deductible
No coverage/liability only
$250 deductible
$500 deductible
$1,000 deductible
Comprehensive/Collision coverage with deductible for Vehicle 2?
Requested Liability Limits for all Vehicles
Select liability
$50,000/$100,000
$100,000/$300,000
$250,000/$500,000
Our agency minimum is $50,000/$100,000.
Claims, Tickets and Accidents
Please list any claims, tickets, and accidents. Put the driver and vehicle involved, along with the type of incident and date of occurrence.
"For Hire" Details
If any vehicle is used for delivery, Uber, Lyft, or any other type of "for hire" basis, please list the details here.
Are the Vehicles Currently Insured?
Yes
No
Current Auto Insurance Provider
Expiration Date of Current Policy
Years with current auto insurance provider
less than 1
1-2
2-3
3-4
4-5
5+
Additional Vehicles
If you have more than 2 vehicles, please list additional year, make, model, VIN, and comprehensive/collision choice here.
Agent
Choose agent
Dede Henderson
Ryan Eaton
Geoff Eaton
If a particular agent helped you, please choose his or her name.
Phone
This field is for validation purposes and should be left unchanged.
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