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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
Start A Quote
Menu
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
Motorcycle Operator (If Not Already On Policy/Household)
Motorcycle/ATV Data
Engine Size/CCs
Usage
Pleasure
Racing
Commute
How many wheels?
2 wheels
3 wheels
4 wheels
Boat or Watercraft Information
Boat Data
Value/Purchase Price
Purchase Date
MM slash DD slash YYYY
Horsepower
Hull Type
Fiberglass
Aluminum
Other
Motor Type
Inboard
Outboard
Jet
Other
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
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)
Call
Email
Claims
Payments
