Get Started: Shop Current Insurance Step 1 of 6 0% Personal InfoName Date of birth MM slash DD slash YYYY Do you have a spouse or significant other? Yes No Email(s)Add all within household Add RemoveBest phone number(s) to reach you?Add all within household Add RemoveText ConsentA quick and easy way to communicate with our customers is via text- we may text you regarding your active quotes or regarding notices on your current policies. Please consent to engage in text conversations with our team by selecting “yes” below. Message frequency varies. Message and data rates may apply. If you select “no” we will communicate via voice and email only. You can opt-out anytime by replying “STOP” to any of our text messages. Yes No Property Info Who referred you to Jefferson Avenue?We love to thank the people who refer our shop. Property Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Untitled Primary Residence Rental Driver's LicenseUpload or Snap Photo(s)Include all licenses from people in the household Drop files here or Select files Max. file size: 300 MB. ListFull NameExpiration Date (MM/DD/YYYY)License #State(Initials) Add Remove Upload Documents Please provide us with all of your most recent insurance declarations pages and insurance quotes you may have gotten thus far, These will be super helpful in helping you compare options. Also, Any interest in bundling? A lot of insurance carriers give huge discounts if they are able to earn the auto and home insurance as a package. If you want us to take a look at your auto insurance too, attach your current insurance documents here. You can find this under the “My policy” or “My documents” tab on your carriers’ website. Declarations Page - Upload or Snap Photo(s)Upload or Snap Photo(s) Drop files here or Select files Max. file size: 300 MB. Additional Documents (if applicable)Upload or Snap Photo(s) Drop files here or Select files Max. file size: 300 MB. Additional Property InfoThis property will be a... Primary Residence Investment/Rental Property Flip Is the property in good shape? Are the electrical, plumbing, heating, and the roof up to date and code? Yes No Do you have any dogs? Yes No Any businesses on or surrounding the home? Yes No How old is the roof? Additional Property Info (cont.)Are there any of the following in the home? Coal/Wood Burning Stoves Swimming Pools Trampolines Fire Breathing Dragons Other Crazy Things None of the Above Additional Info Hey, if you don’t do online forms, no hard feelings. Feel free to opt out and talk to a real person! (610) 260-3078 service@jeffersonaveinsurance.com