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Choice Insurance Agency, LLC - Insuring Virginia Residents & Businesses for Decades!
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Personal Auto, Homeowners Insurance from Choice Insurance Agency, LLC
Personal Auto Insurance

INSTANT Progressive Quote

Homeowners Insurance

Renters Insurance

Boat Insurance

Business, workers comp, and Contractor Insurance Products from Choice Insurance Agency, LLC


General Liability Insurance

Workers Comp Insurance

Commercial Auto Insurance


Life and Health Insurance Products from Choice Insurance Agency, LLC
Life Insurance

Individual Health Plans

Group Health Plans

Long Term Care Insurance


Other Insurance Services from Choice Insurance Agency, LLC
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Our Privacy Notice

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Choice Insurance Agency, LLC is a Trusted Choice Agency!
 
On-Line Renters
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Personal Data:
 
Your Name:
Property Address:
City:
State: (Must be Virginia)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail (again for accuracy):
Phone:
Fax (optional):
 
Dwelling Information
 
Year Dwelling Built:
Home Square footage:
 
# Units in common bldg.:
 
Type Roof: Shingle Wood Shake
Tar/Gravel Spanish Tile
 
Number of stories: One Two
Three 4+
 
Do you own animals or pets? Yes No
If yes, list type/for dogs, list breed:
 
Are You Near Brush Area? Yes No
 
# of feet to nearest
fire hydrant: 		# of miles to nearest
fire station:
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
 
Circuit Breakers or fuses? Breakers Fuses


# Fireplaces: # Chimneys:
 
Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)
 
Coverages:
 
Contents $ Loss of Use $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone
Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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Choice Insurance Agency, LLC . 4664 South Boulevard . Virginia Beach, VA 23452
Phone: 757-416-5100 | Fax: 757-523-2799 | E-Mail us at: tom.freridge@choiceins.com
Our Telephone Quoting Hours are: 9:00am to 5:00pm (Mon-Fri)
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