Personal Auto Form

Nice to Meet You! Please let us know a little bit about yourself.
Before we begin, quick question: will you be able to upload a picture of the drivers license for ALL drivers in your house?*
- Yes
- No
- I will email them later
You can also email them to mycar@deerinsurance.com.
Applicant / Insured*
First Last
Gender*
- Male
- Female
Cell Phone Number*
Do you approve text messages?*
- Yes
- No
Email
Marital Status*
- Single
- Married
- Divorced
- Widow
- Separated

Address*

(House/Apt Number, Street, City, State, Zip)

In what year did you move to this address?*
Highest Level of Education*
- High School Diploma
- Some College Education
- College Degree or More
- Military
Are you retired?*
- Yes
- No
Occupation*
Employer*

List all drivers in your home*

Full Name	DOB (MM/DD/YYYY)	Drivers License Number	License State	Age When First Licensed	Any Violations or Accidents?	Vehicle Most Driven

Use the + sign to add more drivers

Do you know your vehicles VIN Number?*
- Yes
- No
- Will upload a picture of the insurance card

Please list all vehicles to be included in the policy*

Year	Make	Model	Vin Number	In what year did you acquired it?

Use the + sign on the right to add more vehicles

Upload a picture or pdf of each vehicle's current insurance card*
Drop files here or

Max. file size: 98 MB, Max. files: 5.
Will any of your vehicles be use for ridesharing or delivery (Uber, Lyft, Papa Johns, etc.)?*
- Yes
- No
Are you currently Insured?*
- Yes
- No
Current Insurance Company*
Expiration Date*
MM slash DD slash YYYY

If you do not know your expiration date, please select the first (1) day of the month that you think it expires.

Upload Documents
Name of person who completes this form*
First Last
Please Upload the Driver's License of ALL Drivers.
Drop files here or

Max. file size: 98 MB, Max. files: 10.
Name of person completing the form*
First Last
Thank you for allowing us to protect your vehicles. We will be providing you with the most complete and honest Auto Insurance Quote.
You are DEER to our heart!

Nice to Meet You! Please let us know a little bit about yourself.