Thank you for your interest in SHS Auto, Home and Life Insurance. Please use the form below to provide the information needed so that we may give you an accurate quote. Please enable JavaScript in your browser to complete this form.Contact InformationName *FirstLastEmail *Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDriver 1 InformationDriver 1 Name *FirstLastDriver 1 Date of Birth *Driver 1 Driver's License Number *Driver 1 Social Security Number *Driver 2 InformationDriver 2 NameFirstLastDriver 2 Date of BirthDriver 2 Driver's License NumberDriver 2 Social Security NumberDriver 3 InformationDriver 3 NameFirstLastDriver 3 Date of BirthDriver 3 Driver's License NumberDriver 3 Social Security NumberDriver 4 InformationDriver 4 NameFirstLastDriver 4 Date of BirthDriver 4 Driver's License NumberDriver 4 Social Security NumberVehicle InformationVehicle 1 Year, Make and Model *Vehicle 2 Year, Make and ModelVehicle 3 Year, Make and ModelVehicle 4 Year, Make and ModelCurrent CoverageLiability LimitsMedical LimitsComprehensive DeductiblesCollision DeductiblesUninsured/Underinsured MotoristUninsured/Underinsured Liability LimitsTowing ReimbursementYesNoRental ReimbursementYesNoAny Losses IncurredPlease list the Date, Description of loss/claim and the amount paidHomeowner InsuranceCurrent CoverageDwelling LimitPersonal Property LimitLiability LimitsDeductibleStructureConstruction YearType of ConstructionMasonryFrameAlarm SystemsYesNoFire DetectorsCentral Fire AlarmLocal BurglarCentral Burglar AlarmBasementYesNoBasement FinishedYesNoScheduled Jewelry LimitAge of RoofAny Losses IncurredPlease list the Date, Description of loss/claim and the amount paidLife InsuranceName *FirstLastDate of BirthSmokerYesNoAmount of coverage requestedUpload your current declaration page(s) here Click or drag files to this area to upload. You can upload up to 10 files. PhoneSubmit