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Personal Information
Name*
Address
Street Address City State ZIP Code
Phone*
Email*
Current Insurance Information
Insurance Company Name (not agency):
Expiration:
MM
DD
YYYY
Years Insured:
Premium Paid:
Policy Term:
- 6 Months
- 1 Year
Vehicle Information
How many cars will be insured?
- 1
- 2
- 3
- 4
Vehicle 1 Information
Year
Make
Model
VIN
Deductibles
Comprehensive
Collision
Other Options
- Towing
- Rental Reimbursement
Vehicle 2 Information
Year
Make
Model
VIN
Deductibles
Comprehensive
Collision
Other Options
- Towing
- Rental Reimbursement
Vehicle 3 Information
Year
Make
Model
VIN
Deductibles
Comprehensive
Collision
Other Options
- Towing
- Rental Reimbursement
Vehicle 4 Information
Year
Make
Model
VIN
Deductibles
Comprehensive
Collision
Other Options
- Towing
- Rental Reimbursement
Liability Limit For ALL Cars
Choose Either:
- Bodily Injury and Property Damage
- Single Limit
Bodily Injury:
Property Damage:
Single Limit:
Personal Injury Protection (PIP):
Medical Payments Coverage Limits:
PIP Deductibles:
Driver Information
Number of Drivers:
- 1
- 2
- 3
Driver 1 Information
Name:
First Last
Relationship:
Drivers License #:
State Issued:
How Long Licensed?:
Date of Birth:
MM
DD
YYYY
Claims and Accidents in past 3 years - include date, amount paid, description)
Driver 2 Information
Name:
First Last
Relationship:
Drivers License #:
State Issued:
How Long Licensed?:
Date of Birth:
MM
DD
YYYY
Claims and Accidents in past 3 years - include date, amount paid, description)
Driver 3 Information
Name:
First Last
Relationship:
Drivers License #:
State Issued:
How Long Licensed?:
Date of Birth:
MM
DD
YYYY
Claims and Accidents in past 3 years - include date, amount paid, description)
Excess Liability
Amount:
Personal Umbrella Coverage:
- Yes
- No
Additional Comments or Questions
Comments
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Customer Reviews

SF

Friendliest and helpful..kind. I really love this agencyshari f., Lexington, Kentucky

Five stars!Janice G., Lenox, KY

Five stars!Earlena D., Kentucky

Five stars!Doug K., Kentucky

Four stars!Tammy R., Prestonsburg, KY

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Lexington Office

Elite Insurance Agency

2408 Sir Barton Way, Suite 325
Lexington, Kentucky 40509

Phone: (859) 264-9400

Mon-Fri: 9:00am-5:00pm
Sat-Sun: Closed

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Paintsville Office

Elite Insurance Agency

450 S Mayo Trail
Suite 1
Paintsville, Kentucky 41240

Phone: (606) 789-8470

Mon-Fri: 9:00am-5:00pm
Sat-Sun: Closed

Inez Office

Elite Insurance Agency

66 Park Place
Suite 104
Inez, Kentucky 41224

Phone: (606) 298-0863

Mon-Fri: 9:00am-5:00pm
Sat-Sun: Closed

Louisa Office

Elite Insurance Agency

306 Commerce Drive
Suite 450
Louisa, Kentucky 41230

Phone: (606) 638-3263

Mon-Fri: 9:00am-5:00pm
Sat-Sun: Closed

Pikeville Office

Elite Insurance Agency

5 Village Street
Suite 1
Pikeville, Kentucky 41501

Phone: (606) 437-0534

Mon-Fri: 9:00am-5:00pm
Sat-Sun: Closed

Prestonsburg Office

Elite Insurance Agency

1135 South Lake Drive
Prestonsburg, Kentucky 41653

Phone: (606) 886-2371

Mon-Fri: 9:00am-5:00pm
Sat-Sun: Closed

Elite Insurance Agency Provides Auto / Car Insurance, Home Insurance, and Business / Commercial Insurance to All of Kentucky, Including Lexington, Paintsville, Inez, Louisa, Pikeville, Prestonsburg, and Martin.

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