Contact

Tim Stuber

Farmers Insurance
Submit Your Insurance Docs

Tim Stuber

Tim Stuber

[email protected]

Submit Your Insurance Docs

CLIENT INFORMATION

You have several options for submitting your client information to us.

Step 1

Click to fill out this form

Step 2

Import your insurance docs

Click here

Or

Upload a pdf of your info

Name(Required)
Drop files here or
Max. file size: 512 MB.

    Personal Information

    Primary Insured Information:

    Name(Required)
    MM slash DD slash YYYY
    Address
    By submitting your mobile number, you agree to receive periodic text messages from us. Standard messaging rates may apply.

    Auto Information:

    Additional Drivers:

    Additional/Secondary Drivers:
    Name
    DOB
    Relationship
    State
    Drivers LIC #
     

    Vehicle:

    Vehicles
    Year
    Make/Model
    VIN#
    Full Coverage or Liability?
     

    Additional Vehicles:

    Vehicles
    Year
    Make/Model
    VIN#
    Full Coverage or Liability?
     

    Dwelling Information

    *Single Family

    -OR- * Townhome/Condo/Renters

    Townhouse only

    Life Insurance:

    Additional:

    Additional

    In connection with this application for insurance, Farmers®️ may review your and your spouse’s credit report or obtain or use a credit-based insurance score based on the information contained in that credit report. We may use third parties in connection with the development of your insurance scores based on data from traditional credit bureaus and the National Consumer Telecom & Utilities Exchange database.

    Do you consent for Farmers®️ entities:

    (1) Is it ok to use any consumer report information our affiliates might currently have for you for this transaction?

    (2) Is it ok to share consumer report information from this transaction with our affiliates to quote other products?

    Consent(Required)

    Business Information

    Drop files here or
    Max. file size: 512 MB.

      Business Information

      Nature of your operation, what does your business do
      Address of the Business Location(Required)
      Mailing address (If different from physical address)

      Contact Information

      By submitting your mobile number, you agree to receive periodic text messages from us. Standard messaging rates may apply.

      Ownership Information

      Ownership Information
      Name of Owners/Partners/Officers
      Date of Birth of Owners/Partners/Officers
       

      Business Details+

      Subs must have their own general liability insurance to be considered subs
      Equipment, tools, PCs, desks, chairs, cabinets, materials, etc.
      Fire extinguisher, smoke detectors
      Landlord, Who is Requesting Cert of Insurance
      Add more

      Building/Property Information +

      Wood frame, concrete, metal
      Need to know all of these
      Add more

      Commercial Auto +

      Name, DOB, Driver's License #
      Add more

      Workers Comp +

      Add more

      Commercial Umbrella

      1,000,000-5,000,000