Personal – RK All Insurance Services

Your Personal Insurance Specialists

We’re here to streamline the hassle for you at a great cost.

Our Personal Coverage:

You can put your trust in RKAIS.

Working with us is easy

With over 20 years in the sector, we take away confusion, save you time, and get your the most affordable plans.

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Agent Name

Quote Needed by Date:

First Name

Last Name

Email

Phone

Mailing Address

Garaging Address

Current Carrier

Effective Date

Driver #1 Info
Date of Birth

License #

Vin #

MM/YR Licensed

Gender

Marital Status

Occupation

Work Address

Relationship to Applicant

Driver #2 Info
Name

Date of Birth

License #

Vin #

MM/YR Licensed

Gender

Marital Status

Occupation

Work Address

Relationship to Applicant

Vehicle Information
Leased or Purchased?

Year

Current Odometer

Annual Mileage Driven

Any Accidents?

If yes, when?

Moving Violation?

If yes, when?

Any additional comments:

Please attach a copy of your current policy

Something isn’t Clear?
Feel free to contact us at (714) 784-5977, and we will be more than happy to answer all of your questions.

Homeowner's Insurance Quote Request

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Agent Name

Date Quote Needed by:

Type of Insurance

Occupancy

Name of Applicant

DOB

Marital Status

Occupation

Email

Phone

Name of Co-Applicant

DOB

Marital Status

Occupation

Property Address

Mailing Address

Date Purchased

Gated Community?

Year Built

Area

Sq Ft

# of Stories

Year Remodeled
Plumbing

Year Remodeled
Cooling

Year Remodeled
Heating

Year Remodeled
Electric

Type of Construction

Roof Type

Burgler Alarm

Sprinkler System

Do you own an animal?

If yes, what type of breed?

Dwelling Amount $

Dwelling Amount $

Personal Property $

Morgagee / Loss Payee Information

Current Insurance Carrier

Expiration Date

Any loss during the last 3 years?

If yes, describe loss

Something isn’t Clear?
Feel free to contact us at (714) 784-5977, and we will be more than happy to answer all of your questions.

Commercial Line Quote Request

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Something isn’t Clear?
Feel free to contact us at (714) 784-5977, and we will be more than happy to answer all of your questions.

Agent Name

General Info
Quote Needed by date

DBA

Insured

Address

Phone

Your Email

Type
Individual Corporation Partnership Other

Type

Website (if any)

Experience in This Business in Years

At this Location in Years

New Venture

If yes, prior experience here

Prior Carrier

Policy#

Proposed effective Date

Loss History

Underwriting Info
Premises

Address

Interest

Loc#1

Construction Type
Frame Jointed Masonry Other

Yr. Built

Building updates - Wiring

Building updates - Plumbing

Building updates - Roofing

Building updates - Heating

Building updates - Total Area in SF

Do you have the following systems?
Burglar Sprinkler

Business Hours

Annual Gross Receipt $

Additional Insured:

Workers Comp
Tax ID

How many full time?

How many part time?

Estimated Total Payroll for Year

Officers
Officer 1 Name

Title

Percent Ownership

Duties

inc/Exc

Officers
Officer 2 Name

Title

Percent Ownership

Duties

inc/Exc

Officers
Officer 3 Name

Title

Percent Ownership

Duties

inc/Exc

Your Personal Insurance Specialists

Our Personal Coverage:

Personal Auto

Home Owners

Condo/Renters

Motorcycle

Personal Umbrella

Personal Liability

Dwelling Fire

Flood / Earthquake

You can put your trust in RKAIS.

Working with us is easy

With over 20 years in the sector, we take away confusion, save you time, and get your the most affordable plans.

Need help? Call our dedicated support team at (714) 784-5977

Contact Info

Insurance

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Auto Quote Request

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Homeowner's Insurance Quote Request

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Commercial Line Quote Request

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