Independent insurance agents
Lets current policyholders share their existing renewal quote amount so agents can comparison shop competing rates without a full underwriting interview.
Auto Insurance Quote Request Template
Make it easy for prospects to request an auto insurance quote online. This template captures vehicle information, driver history, mileage, primary use, and desired coverage level — everything your team needs to return a competitive quote quickly. No coding required, ready to embed or share as a link.
Free for non-commercial projects, with unlimited forms and responses.
Last updated
About this template
An auto insurance quote request form is the digital front door for insurance agencies and carriers looking to convert online visitors into policyholders. Instead of phone tag and back-and-forth emails, the form captures all the underwriting essentials in one structured submission — vehicle details, driver history, annual mileage, current coverage status, and desired protection level — so your team can return an accurate quote with minimal delay.
More about this template
The difference between a good quote form and a great one is the questions it asks. Too few fields and your agents are still calling to gather missing data. Too many and prospects abandon before finishing. This template hits the right balance: it asks for every variable that meaningfully affects a premium (vehicle, mileage, use, accidents, coverage lapse) while keeping the experience short enough to complete in under two minutes.
formformform makes it simple to publish this form as a standalone link or embed it directly on your agency website. Every submission lands in your dashboard and triggers an instant email notification, so you can reach out to prospects while their interest is highest. No subscription fees, no submission caps, and no complicated setup.
12 fields to make your own11 required in this starting form
Make it fit your workflow.
Use your own copy to change labels, remove questions and add the details you need. Try the preview alongside this guide to see what respondents will be asked.
The questions, explained
Fields in this template
Review the starting questions and choices. You can change them in your own copy.
Full Name
Jane Smith
Email Address
jane@example.com
Phone Number
(555) 123-4567
Vehicle Year
2021
Vehicle Make and Model
Toyota Camry
Annual Mileage
12000
Primary Use of Vehicle
4 choices
- Daily commute
- Personal / leisure
- Business use
- Rideshare / delivery
Current Insurance Provider
State Farm, Geico, None, etc.
Any lapse in coverage in the past 6 months?
2 choices
- No, continuously insured
- Yes, there was a lapse
Years of Driving Experience
10
At-Fault Accidents in Past 3 Years
0
Desired Coverage Level
5 choices
- Minimum liability only
- Standard liability + collision
- Comprehensive coverage
- Full coverage with extras
- Not sure — I'd like guidance
Where it fits
Who uses this template
Suggested uses, and why this starting point can help. Adapt the questions to your own process.
Insurance brokerages
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Vehicle Make and Model” in particular and adapt it to the detail you need.
Auto insurance carriers
Includes deployment status, base location, vehicle storage during deployment, and eligibility for military-specific discounts with USAA and similar carriers.
Insurance comparison websites
Lets current policyholders share their existing renewal quote amount so agents can comparison shop competing rates without a full underwriting interview.
Credit unions with insurance programs
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Current Insurance Provider” in particular and adapt it to the detail you need.
Dealerships offering insurance referrals
Use this as a starting point when you need the same essential information from each person. Review the questions against your process before sharing your copy. Review “Any lapse in coverage in the past 6 months?” in particular and adapt it to the detail you need.
What's included
Vehicle year, make, and model capture
Annual mileage and primary use fields
Driver history — years licensed and accident count
Coverage lapse question for underwriting accuracy
Desired coverage level dropdown
Current insurer field for competitive analysis
Mobile-friendly for on-the-lot use
Instant email notification on every submission
How to create an auto insurance quote request
- 1
Click 'Use this template' to start with this auto insurance quote form pre-built in your free formformform account.
- 2
Customize the vehicle fields if you specialize in specific vehicle types — for example, add a field for motorcycle CC rating or commercial vehicle class.
- 3
Add a ZIP code or state field if your rates vary significantly by location.
- 4
Set your notification email address so every quote request hits your inbox immediately.
- 5
Connect the form to your CRM or agency management system using the webhook integration if needed.
- 6
Copy the share link or embed code and add the form to your website's 'Get a Quote' page.
Best practices for your auto insurance quote request
Ask for vehicle VIN optionally
some prospects won't have it handy, but offering the field saves a follow-up call for those who do.
Include a coverage lapse question
insurers rate lapsed drivers differently, and knowing upfront prevents quoting errors.
Keep mileage as a number field
avoid dropdowns like '10,000–15,000' that introduce ambiguity into underwriting calculations.
Add a ZIP code field
auto premiums vary dramatically by territory, and having it upfront means no extra contact needed.
Set realistic required vs. optional fields
make name, email, vehicle year/make, and mileage required; make current insurer and VIN optional.
Respond within the hour
auto insurance shoppers are comparison shopping across multiple agents simultaneously; first responder often wins.
12 form ideas you can build with this template
Teen Driver Auto Insurance Quote Form
Collects parent and teen driver details, GPA for good-student discounts, and vehicle specs for families adding a new young driver to their policy.
Classic Car Insurance Quote Request
Captures agreed-value preferences, vehicle storage conditions, annual mileage limits, and vehicle appraisal status for collectible and vintage automobile coverage.
Commercial Vehicle Insurance Quote Form
Gathers DOT number, fleet size, cargo type, and driver roster information for trucking companies and delivery fleets seeking commercial auto coverage.
Rideshare Driver Insurance Quote Form
Asks about rideshare platform (Uber, Lyft, DoorDash), weekly hours driven, personal versus commercial policy gaps, and vehicle year/model for gig economy drivers.
High-Value Vehicle Insurance Quote Form
Collects vehicle purchase price, modifications, storage type, and agreed-value versus stated-value preferences for exotic, luxury, or high-performance cars.
SR-22 Insurance Quote Request
Asks about license suspension reason, reinstatement date, and state requirements for drivers who need an SR-22 filing to restore driving privileges.
Non-Owner Auto Insurance Quote Form
Captures driving frequency, typical vehicle types used, and liability coverage needs for drivers who borrow or rent vehicles but don't own one.
Military Member Auto Insurance Quote Form
Includes deployment status, base location, vehicle storage during deployment, and eligibility for military-specific discounts with USAA and similar carriers.
New Driver Auto Insurance Quote Form
Collects date of licensure, driver's education completion, parent/guardian co-insured status, and vehicle value for newly licensed drivers seeking their first policy.
Motorcycle Insurance Quote Form
Asks about motorcycle type (cruiser, sport, touring), engine CC, safety course completion, and seasonal storage for riders seeking moto-specific coverage.
Snowmobile and ATV Insurance Quote Form
Captures off-road vehicle type, usage (recreational vs. agricultural), storage location, and trailer towing needs for powersports equipment owners.
Auto Insurance Re-shop Form for Existing Policyholders
Lets current policyholders share their existing renewal quote amount so agents can comparison shop competing rates without a full underwriting interview.
Frequently asked questions
Can I add multiple vehicles to a single quote request form?
Yes — you can duplicate the vehicle fields section (year, make/model, mileage) and label them 'Vehicle 1' and 'Vehicle 2', or add a number field asking how many vehicles the applicant wants to insure before letting your team follow up for details.
How do I receive quote requests from the form?
Every submission is emailed to you instantly and stored in your formformform dashboard. You can also set up a webhook to push submissions directly into your CRM or agency management platform.
Is this form HIPAA or PII compliant?
formformform collects and stores form data securely. For regulated insurance operations, review your state's data handling requirements and consider adding a privacy notice to the form using a paragraph field.
Can I ask about additional drivers on the policy?
Yes — add fields for secondary driver name, relationship, date of birth, and driving history. You can use a 'divider' to separate primary and secondary driver sections cleanly.
What if I only want to collect inquiries, not full quotes?
You can remove the driver history and coverage-level fields to create a lighter 'request a callback' form that captures just the basics for an initial conversation.
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