QuoteMe Intake
Secure intake for quoting

Give the quoting agent what they actually need.

This intake is designed to gather the information required for an accurate insurance quote the first time. Removing too many underwriting questions only creates follow-up calls, missing details, and delays.

Structured for personal and specialty insurance intake.
Built to reduce incomplete submissions and back-and-forth email.
Does not request Social Security numbers or similar high-risk identifiers in this form.

Insurance quote request

Please complete the sections that apply to your request.

Approx. 5–10 minutes

Contact details

Tell us how the receiving agent should contact you and who the quote is for.

Insurance type

Select the coverage type that best matches what you want quoted.

Coverage requested
Select an insurance type to reveal the quote questions specific to that line of business.

Auto quote details

Collect driver, vehicle, prior coverage, and loss details needed for accurate auto pricing.

Homeowners quote details

Please provide the property, occupancy, and protection details needed for accurate homeowners quote review.

Mitigation report
4-point inspection
Roof inspection / certification
We do not ask for Social Security numbers in this form. If additional protected information is needed later, the receiving licensed agent should request it directly by phone.

Condo quote details

Collect unit details, occupancy, association information, and desired contents/liability coverage.

Renters quote details

Collect occupancy, landlord/property details, contents value, and any liability concerns.

Flood quote details

Flood quoting depends on location, elevation, occupancy, and building characteristics.

Life insurance details

Collect the basics needed before a life quote conversation and underwriting review.

Boat / watercraft details

Collect hull, motor, storage, usage, and operator information.

Motorcycle details

Collect cycle details, riders, prior coverage, and violation history.

Golf cart details

Collect cart, usage, driver, and storage information for accurate rating.

Commercial / business details

Collect the type of business, operations, payroll/revenue, vehicles, and property exposures.

Coverage goals

Tell the receiving agent what matters most so the quote can be structured appropriately.

Privacy reminder

This intake is for quote preparation only. Please do not include Social Security numbers, banking details, or other highly sensitive identity information in this form.

By submitting, you authorize contact regarding your request for insurance quote review.

Landmark Insurance Agency, Inc. intake form for prospective insurance quote requests.