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Keep in mind: If we cannot presently find you a better rate, it may because your current insurance company has not raised your rate yet. This can happen when you're mid policy. Your increase may not occur until your policy renews, even if you have already added the SR22 filing for a small fee.
If we aren't able to find you a better rate now, we will requote when your current policy is due to be renewed at a higher rate. This should not require any more of your time.
Name:
Yes/No -- Select an option -- Yes No
Date of DUI
Select Date
Rent Own
-- Select an option -- Home Apartment Condo Mobile Home Fixed Mobile Home
-- Select an option -- Yes No
-- Select an Option -- Commute/Personal (to/from work or school, errands) Pleasure (used for recreational driving only) Business (used for duties related to the insured's job) Farm
Years
Months
Prior Address
Prior City
Prior State
Prior Zip
Make a Selection -- Select an option -- Single Married Separated Divorced
Make a Selection -- Select an option -- Vehicle is not insured Less than 1 year At least 1 year but less than 3 years At least 3 years but less than 5 years 5 years or more
Deliver Passengers: Yes No
Deliver Products: Yes No
Make a Selection -- Select an option -- Homemaker (full-time) Retired (full-time) Unemployed Student (full-time) Agriculture/Forestry/Fishing Art/Design/Media Banking/Finance/Real Estate Buisness/Sales/Office Construction/Energy/Mining Education/Library Engineer/Architect/Science/Math Food Service/Hotel Services Government/Military Information Technology Insurance Legal/Law Enforcement/Security Medial/Social Services/Religion Personal Care/Service Production/Manufacturing Repair/Maintenance/Grounds Sports/Recreation Travel/Transportation/Storage
Occupation
Make a Selection -- Select an option -- No High School Diploma High School Diploma Vocational/Technical Degree Some College - No Degree Currently in College Associates Degree Bachelors/Masters Degree
Make a Selection -- Select an option -- Valid Regular / Occupational (restricted) License Permit / Not licensed yet Suspended Permanently Revoked Expired Not Licensed Commercial/Business Other If other please specify
Make a Selection -- Select an option -- Personal Auto Commercial Vehicle/Business (non-chauffeur) Chauffeur Permit Not Licensed/State ID If other please specify
-- Select an option -- Yes, currently insured Yes, not currently insured No
I agree to allow Lucent Insurance Group LLC to use any data given to my interlock provider for purposes of processing insurance quotes with Lucent Insurance Group's insurance carriers.
Additionally, I acknowledge, that insurers use information from me and other sources, such as my driving, claims and credit histories, to calculate an accurate price for my insurance. New or updated information may be used to calculate my renewal premium.
I have read the above disclosure and agree to proceed.
Last Step! To save you time and money, it is important that we obtain the Declarations page from your current insurance policy. Your Declaration page tends to be the first page among your auto insurance documents. If you cannot locate your insurance documents, generally you can obtain them in the "documents" section of an online account, or you can just request a copy of the "Declarations Page" from your insurer. Upload a picture of your Declarations page from your phone or attach a copy from your computer below.
Declarations Sheet:
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