Personal Quote Request

What would you like a quote for? Check all that apply:*
- Auto
- Home
- Condo
- Renters
- Rental Property
- Motorcycle
- Boat & Jet Ski
- Umbrella
Primary Policyholder Name*
First Last
Please Enter your name.
Date of Birth*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Rental Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Driver Names and dates of birth*
First Last Date of Birth

Please enter all drivers names and dates of birth.
Are there any tickets or accidents in the last 5 years?*
- Yes
- No
Tickets or accidents in the last 5 years?
Driver Name Incident Type Approximate Date
Vehicle Information*
Year Make Model
Boat Information*
Year Make Model Engine HP Length Value
Your Phone Number*
Phone Number
Your Email*

Email Address
How did you find our agency?*
- Google Search
- Facebook Page/Post
- Facebook/Instagram Ad
- Google Ad
- Customer Referral
Who referred you to us?*
Current Insurance Provider*

Please enter your current insurance provider, how long you have been with them, and what your coverage limits are currently if you have them.
If you have any other questions, comments or requests, please leave them here, thank you!

Request Your Proposal Here

Are you ready to save time, aggravation, and money? The team at Magas Insurance is here and ready to make the process as painless as possible. We look forward to meeting you!

Start Here

First	Last	Date of Birth

Driver Name	Incident Type	Approximate Date

Year	Make	Model

Year	Make	Model	Engine HP	Length	Value