Home
About
Our Company
Our Team
Testimonials
Insurance Carriers
Blog
Get Quotes
Auto Insurance Quote
Business Insurance Quote
Health Insurance Quote
Homeowners Insurance Quote
Life Insurance Quote
Recreational Insurance Quote
Tools
Make a Payment
Report a Claim
Update Contact Info
Policy Change
Proof of Insurance
803-996-0401
MAKE A PAYMENT
Customer Portal
803-996-0401
Personal
Business
Careers
Contact
Contact Us
Contact Carrier
Free Consultation
Home
About
Our Company
Our Team
Testimonials
Insurance Carriers
Blog
Get Quotes
Health Insurance Quote
Home Insurance Quote
Life Insurance Quote
Recreational Insurance Quote
Tools
Make a Payment
Policy Change
Proof of Insurance
Report a Claim
Update Contact Info
Personal
Business
Contact
Contact
Contact Carrier
Free Consultation
Auto Insurance
Home Insurance
Business Insurance
Health Insurance
Life Insurance
Recreational Insurance
Home Insurance
Fill out our form to receive your quote today.
Name
*
First
Last
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
*
Phone
*
Coverage Effective Date:
Vehicle information
Year
*
Make
*
Model
*
VIN
*
Vehicle uses
-Please Select-
Business
Pleasure
School
Work
Name on title
*
Loan/lease company
Ownership
*
Lease
Loan
Own
Comprehensive & collision coverage?
*
Yes
No
Is this vehicle used for any business purpose including ride sharing services?
*
Yes
No
Add Another Vehicle?
Yes
No
Year
*
Make
*
Make
*
Model
*
VIN
*
Vehicle uses
-Please Select-
Business
Pleasure
School
Work
Name on title
*
Loan/lease company
Ownership
*
Lease
Loan
Own
Comprehensive & collision coverage?
*
Yes
No
Is this vehicle used for any business purpose including ride sharing services?
*
Yes
No
Add Another Vehicle?
Yes
No
Year
*
Make
*
Model
*
VIN
*
Vehicle uses
-Please Select-
Business
Pleasure
School
Work
Name on title
*
Loan/lease company
Ownership
*
Lease
Loan
Own
Comprehensive & collision coverage?
*
Yes
No
Is this vehicle used for any business purpose including ride sharing services?
*
Yes
No
Add Another Vehicle?
Yes
No
Year
*
Make
*
Model
*
VIN
*
Vehicle uses
-Please Select-
Business
Pleasure
School
Work
Name on title
*
Loan/lease company
Ownership
*
Lease
Loan
Own
Comprehensive & collision coverage?
*
Yes
No
Is this vehicle used for any business purpose including ride sharing services?
*
Yes
No
Add Another Vehicle?
Yes
No
Year
*
Make
*
Model
*
VIN
*
Vehicle uses
-Please Select-
Business
Pleasure
School
Work
Name on title
*
Loan/lease company
Ownership
*
Lease
Loan
Own
Comprehensive & collision coverage?
*
Yes
No
Is this vehicle used for any business purpose including ride sharing services?
*
Yes
No
Add Another Vehicle?
Yes
No
Year
*
Make
*
Model
*
VIN
*
Vehicle uses
-Please Select-
Business
Pleasure
School
Work
Name on title
*
Loan/lease company
Ownership
*
Lease
Loan
Own
Comprehensive & collision coverage?
*
Yes
No
Is this vehicle used for any business purpose including ride sharing services?
*
Yes
No
Driver information
Driver's name
*
Date of birth
*
Drivers License #
*
Marital Status
*
Single
Married
Annual mileage
*
Miles (estimated)
Has completed driver training
Qualifies for the good-student discount
Accidents or violations in past 5 years
include date and type of incident
Add Another Driver?
Yes
No
Driver's name
*
Date of birth
*
Drivers License #
*
Marital Status
*
Single
Married
Annual mileage
*
Miles (estimated)
Has completed driver training
Qualifies for the good-student discount
Accidents or violations in past 5 years
include date and type of incident
Coverage information
Do you currently have auto insurance, or have you had it within the last six months?
Yes
No
Liability & Uninsured Motorist
*
-Please Select-
25,000/50,000/25,000
50,000/100,000/50,000
100,000/300,000/100,000
250,000/500,000/100,000
50,000 CSL
100,000 CSL
300,000 CSL
500,000 CSL
Comprehensive Deductible
*
-Please Select-
0
100
250
500
1,000
2,500
None
Collision Deductible
*
-Please Select-
0
100
250
500
1,000
2,500
None
Coverage options
GAP / replacement cost
Medical payments (1,000)
Medical payments (5,000)
Medical payments (10,000)
Rental reimbursements
Towing & roadside assistance
Comments
Comments
How Did You Find Us?
*
-Please Select-
Internet Search
Facebook
Twitter
Other
Insurance score agreement
*
In order to obtain this quote, an insurance score may be ordered by one or more insurance companies during the rating process. By checking the box, you are authorizing Landers Insurance Agency, Inc and/or its insurance company partners to order this score as needed in conjunction with obtaining the requested quote.
Comments
This field is for validation purposes and should be left unchanged.