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Address:
202 S Cedar St Ste E
Owasso, OK 74055
Phone:
(918) 973-6773
Email:
NIKI@EXTRAMILEINS.COM
Why Us?
Team
Testimonials
Leave Us A Review
Refer Friends & Family
Our Privacy Policy
Terms of Service
Accessibility
Products
Personal Insurance
Commercial Insurance
Contact
Contact Our Office
Service Center
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Cross Sell
Name
First
Last
Phone
What line of business are we quoting/adding?
(Required)
Auto
Home
Rental Property
Motorcycle/ATV
Watercraft
Auto Information
New Drivers Not Already On Policy/Household
First Name
Middle Name
Last Name
Date of Birth
MM slash DD slash YYYY
Gender
Male
Female
Unknown
Non-Binary
Marital Status
Single
Married
Widowed
Separated
Divorced
Domestic Partner
Civil Union
Fiancé / Fiancée
Unknown
Other
Relationship
Named Insured
Spouse
Parent
Child
Other
Driver's License Number
Occupation
Add driver
Remove driver
New Drivers Not Already On Policy/Household
Vehicle(s) To Be Added
VIN
Year
Make
Model
Ownership
Owned
Leased
Financed
Usage
To/From Work or School
Pleasure Use
Low Mileage (under 4k)
Rideshare
Collector Car
Salvage/Project Car
Other
Add vehicle
Remove vehicle
Vehicle(s) To Be Added
If any driver had accidents, tickets, or license issues in the past 5 years, please describe:
Type of coverage requested
(Required)
Full Coverage
Liability Only
Include Roadside Assistance?
Yes
No
Include Rental Reimbursement?
Yes
No
Motorcycle Information
VIN
Year
Make
Model
Engine Size/CCs
Usage
Pleasure
Racing
Commute
How many wheels?
2 wheels
3 wheels
4 wheels
Who is the main operator?
First
Last
Boat or Watercraft Information
VIN
Year
Make
Model
Who is the main operator?
First
Last
Horsepower
Value/Purchase Price
Purchase Date
MM slash DD slash YYYY
Hull Type
Fiberglass
Aluminum
Other
Motor Type
Inboard
Outboard
Jet
Other
Engine VIN
Engine Year
Engine Make
Engine Model
Length (in feet)
Top Speed
Trailer Included
Yes
No
Usage
Pleasure
Fishing
Racing
Other
Storage Location
Home
Marina
Other
Is the boat kept in or out of water when not in use
Yes
No
Marina Name
Marina Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Any claims or losses in the past 5 years
Yes
No
Claim Details
Home or Rental Property
List Address If Different From What’s On File
Street
Address Line 2
City
State
Zip
Property Type
Primary
Secondary
Rental
Rental Status
Short Term Rental or AirBnB
Long Term Rental
Property Occupancy
Currently Occupied
Vacant
Structure Type
Single Family
Multi Family
Condo
Mobile or Manufactured Home
Other
Is this a new purchase?
Yes
No
Purchase Price
How many stories is the home?
Square Footage
Year Built
Age Of Roof
How many bathrooms? (i.e. 1.5, etc.)
Type of Roof
Asphalt Shingle
Wood Shingle
Metal
Flat
Other
Type of Siding
Vinyl
Wood
Cement
Metal
Other
Do you own a dog?
Yes
No
Dog breed
Swimming Pool or Trampoline?
Yes
No
Describe any improvements (and what year) to roof, electrical, HVAC, or plumbing
Describe any homeowners claims within past 5 years, if any:
Final Notes (pushed to AZ)
Untitled
Call
Email
Claims
Payments
