Auto Insurance Quote Request — Kickoff intake form (public) for Insurance. Standalone version — a hosted mini landing page (an embeddable twin is also available).

Tell us about your drivers and vehicles and we’ll shop your coverage. This is a request for a quote, not a binding of coverage — and we never ask for Social Security or driver-license numbers here.

What it collects (by section):

• About you — First name [short text]; Last name [short text]; Email address [short text].
• Drivers & vehicles — Driver Roster (names/license state) [long text]; Vehicle Roster Summary [long text]. Names and the state each license was issued in — never full license numbers — and a quick list of vehicles.
• Coverage & timing — Policy Intent [dropdown: New / Renewal review / Remarketing]; Target Effective Date [date]; Primary Liability Limit Target [dropdown: $300k / $500k / $1M / $2M / $5M / …]; Primary Deductible Preference [dropdown: $500 / $1k / $2.5k / $5k / $10k / …].
• Your situation — Current Carrier(s) (names only) [long text]; Claims in Last 5 Years (count) [number]; Insurance Notes (client-specific) [long text].

Required: Email address, Driver Roster (names/license state) (kept low-friction).

Form type: Kickoff intake (in), public. Niche: Insurance. Deployment: standalone.

Best for / surface when: Insurance client workflow — auto insurance quote request.