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GET A QUOTE - HOME & AUTO BUNDLE

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Personal Information

*First Name

*Last Name

*Phone Number

*Gender

Male

Female

*Date of Birth

*Email

*Marital Status

Spouse or Partner Information (If Applicable)

First Name

Last Name

Gender

Male

Female

Date of Birth

Location Information

*Address to be Insured

*City

*State

*Zip Code

Additional Information

Number of Years at Current Home

If less than 3 years, please provide previous address.

Previous Address

City

State

Zip Code

Current Insurance Company

Policy Expiration Date/Date of Quotes to Take Effect

*Number of Occupants

*How Many Children

*Number of Pets

Breed(s) if Dog(s)

*Roof Age if Known (or Estimate of Age)

*Any home claims in the last 5 years

Yes

If Yes, Date and Description of Event

*Any Lapse in Coverage in the last 5 years

Yes

*Is Your Auto Insurance with the Same Company

Yes

If No, Current Auto Insurer and Expiration Date

*Names, Date of Birth, Drivers License Numbers for All Drivers on the Policy

*Year, Make, and Model for All Vehicles

*VIN Numbers for All Vehicles

*Any auto claims in the last 5 years?

Yes

if yes, enter date and description of event

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Legal

All content featured on Summit Hill Insurance's website is copyrighted. Please note that we reserve the right to update and/or change any information as required.

Contact

1550 SW Market St., #120.
Lees Summit, MO 64081

tel: (816) 554-7655
fax: (816) 554-0122

Business Hours

Monday through Thursday
9:00 a.m. to 5:00 p.m.
Fridays 9:00 a.m. to 4:00 p.m.