Auto Insurance | Schmidt Insurance Group

About You

Please tell us a little more about yourself.

Full Name(Required)

Date of Birth(Required)

Phone(Required)

Email(Required)

Marital Status(Required)

Gender as listed on your driver's license(Required)

Your Spouse

Spouse Name(Required)

What's your spouse's gender, as listed on their driver's license?(Required)

Spouse Date of Birth(Required)

Next, let's get your address...

Address(Required)

Street Address City State ZIP Code

Do you rent or own your home?(Required)

Own

Rent

Your Vehicle(s)

Now lets gather some details about your vehicles...

How many vehicles do you want coverage for?(Required)

If you need insurance for more than 4 vehicles, please complete the details for the first 4 and we will contact you regarding any additional vehicles.

Vehicle Details

Vehicle 1 Details

Make(Required)

Model(Required)

Year(Required)

Own or Lease?(Required)

Primary Use(Required)

Helpful Hint:
Personal: To/from work / school, errands, leisure
Business: Sales calls, business errands
Commercial: Pizza delivery, couriers, taxis, snow plows
Farming: Agricultural vehicles

Coverage Amount Desired(Required)

Example: 25/50/15
The numbers define the amounts that would be paid out in an at-fault-accident as follows:

First Number: Bodily Injury per person in tens of thousands ($25,000)
Second Number: Bodily injury per accident ($50,000)
Third Number: Property damage per accident in tens of thousands ($15,000)

25/50/15

50/100/50

100/300/50

250/500/100

Unsure, I need some advice

Vehicle 2 Details

Make (Vehicle 2)(Required)

Model (Vehicle 2)(Required)

Year (Vehicle 2)(Required)

Own or Lease? (Vehicle 2)(Required)

Primary Use (Vehicle 2)(Required)

Coverage Amount Desired (Vehicle 2)(Required)

25/50/15

50/100/50

100/300/50

250/500/100

Unsure, I need some advice

Vehicle 3 Details

Make (Vehicle 3)(Required)

Model (Vehicle 3)(Required)

Year (Vehicle 3)(Required)

Own or Lease? (Vehicle 3)(Required)

Primary Use (Vehicle 3)(Required)

Coverage Amount Desired (Vehicle 3)(Required)

25/50/15

50/100/50

100/300/50

250/500/100

Unsure, I need some advice

Vehicle 4 Details

Make (Vehicle 4)(Required)

Model (Vehicle 4)(Required)

Year (Vehicle 4)(Required)

Own or Lease? (Vehicle 4)(Required)

Primary Use (Vehicle 4)(Required)

Coverage Amount Desired (Vehicle 4)(Required)

25/50/15

50/100/50

100/300/50

250/500/100

Unsure, I need some advice

Additional Drivers

Are there additional drivers in the same household?(Required)

ADDITIONAL DRIVER 1

GREAT, WE'RE ALL DONE 🙂

Please click on the "Get a Quote" button below to submit yoiur information.
By providing this information, you're letting us know that it's okay to contact you about this quote.

Full Name(Required)

Date of Birth(Required)

GREAT, WE'RE ALL DONE 🙂

Please click on the "Get a Quote" button below to submit yoiur information.
By providing this information, you're letting us know that it's okay to contact you about this quote.

ADDITIONAL DRIVER 2

Full Name(Required)

Date of Birth(Required)

ADDITIONAL DRIVER 3

Full Name(Required)

Date of Birth(Required)

ADDITIONAL DRIVER 4

Full Name(Required)

Date of Birth(Required)

How Did You Hear About Us?(Required)

By providing this information, you're letting us know that it's okay to contact you about this quote.

Mon - Fri:	9:00 AM - 5:30 PM
Sat:	Available by appt.
Sun:	Closed