Get A Quote - Lighthouse Commercial Insurance PA, NJ, DE, Tristate Area

Name

Zip Code

What type of insurance are you looking for?

How many personal vehicles would you like insured?

How many commercial vehicles would you like insured?

Street Address

Suite, Apt., etc.

City

Zip Code

State

Have you lived here longer than 3 years?

What is the VIN of the first car?

Where is the first car garaged? (please leave an address)

Who drives the first car?

What is the VIN of the second car?

Where is the second car garaged? (please leave an address)

Who drives the second car?

What is the VIN of the third car?

Where is the third car garaged? (please leave an address)

Who drives the third car?

What is the VIN of the fourth car?

Where is the fourth car garaged? (please leave an address)

Who drives the fourth car?

Company Website URL

Please select what applies to you and your business

This is a home-based business.

I have multiple locations.

You own the location(s) your business operate in.

How many locations does your business operate at?

Are you insuring a property?

Who is your current carrier?

What is the effective date of your current policy?

Are there current/pending claims with your business?

Please provide additional details regarding this claim.

Your home’s security features can impact your policy and premium. Have you installed any of the following safety devices?

Burglar alarm that sounds

Fire alarm that reports to a fire station or security company

Multiple fire sprinklers throughout your home

A backup generator

Home automation system

Have you made any claims in the past 5 years?

Please provide additional information regard this/these claim(s)

Do you smoke?

Do you own any dogs?

How many dogs do you own?

Who is your current carrier?

What is the effective date of your commercial auto policy?

Are you currently insured?
Yes No

What is the effective date of your current policy?

What carrier is your current policy with?

Please describe your current coverage (include deductibles)

Please tell inform us of any desired changes to your current coverage

What methods would you prefer us you contact with?

Phone

Phone Number

Email Address

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