Long Term Care

At Allegiance First Insurance, we want to make a difference.

To begin the online submission process, please check the necessary boxes below.

We want to assist with you policy needs. Please check 'Yes' for an Allegiance First Agent to contact you. However, check 'No' if you want to continue with the Online Process *

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Ready to Get Your Quote?

Please answer the required questions to get the coverage that you need.

Insurance Services *

Auto
Home
Home & Auto

You can choose more than one option.

What other coverage did you need?

Current Address Different from Home Address *

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No

Name *

First

Last

Date of Birth *

MM/DD/YYYY

Marital Status *

Gender *

Where Can We Send Your Quote?

Please enter your email and phone.

Email *

Phone *

Let's Get to Know You

Please pick the category that best describes you

Education *

Occupation *

Great, Let's Get Your Driver's License.

Driver's License Number *

Driver's License State *

Age Licensed *

Are You Adding an Additional Applicant *

Yes
No

If 'Yes', Please list them

Name of Additional Applicant

First

Last

Date of Birth

MM/DD/YYYY

Marital Status

Please Tell Us About the Vehicle that You're Insuring

VIN *

Year *

Make *

Body Style *

What's the Primary Use of Vehicle?

Layout

Primary Use *

Annual Milage *

Ownership Type *

Tell Us About the Home You're Insuring

These questions will help us determine the type of construction of your home. Please answer the questions as best as you can.

Layout

Primary Use of Home *

Square Footage *

How Many Bedrooms *

How Many Bathrooms *

Roof Type

Please answer as best you can.

Roof Update Year

When was the Plumbing Updated?

Please answer as best as you can.

Do You Have a Dog?

Dogs are like family. However, they can raise your insurance depending on the breed.

Breed of Dog

Property Type

Just a Few More Questions About Your Home

These questions are about the type of foundation the home is on.

Please answer the questions as best as you can.

What's the Foundation of Your Home?

This describes the land under the property. Foundations or basements can increase the replacement cost of your home.

Is there a Basement?

What's the Heating/Cooling Source for Your Home?

You can skip ahead if you're not sure.

Heating

Cooling

Does Your Home Have a Fireplace?

Fireplaces are great to get cozy up to, but there's an increase risk of insuring your home.

Type of Fireplace

Number of Fireplaces

Does Your Home Have a Wood Burning Stove?

Number of Wood Burning Stoves

Do You Have a Pool?

What Type of Pool?

Is Pool Fenced

Do You Have a Homebased Business?

How Many Employees?

Insurance

Tell Us About Your Previous Insurance Policies

Please give as much detailed information as possible.

Had Prior Home Insurance

Previous Insurance Company

Were There any Losses or Claims with Previous Insurance?

Please tell us any incident history for the last five years.

Had Claim

Explain Loss Type

Loss Date

Loss Amount

Year Built *

How Many Stories *

Tell Us About the Construction of Your Home

If you're not sure, then Skip this section.

Is Home Being Remodeled Or Under Construction?

Home Structure