Request a personal auto insurance quote from Susman Insurance Agency, an independent, family-owned agency in Los Angeles. About 10 minutes; a licensed agent reviews every request.

1. Full Name (required)
2. How did you find us? (required; choices: Search engines / Social media / News story / Referral / I am a current client of Susman Insurance)
3. Name of Referral (required; only when applicable)
4. Are you working with one of our agents? (required; choices: Yes / No)
5. Agent's Name (required; only when applicable)
6. Cell Phone (required)
7. Home Phone (required)
8. Email (required)
9. Mailing Address - Street (required)
10. Mailing Address - Line 2 (optional)
11. Mailing Address - City (required)
12. Mailing Address - State (required)
13. Mailing Address - ZIP (required)
14. Have you moved in the last 3 years? (required; choices: Yes / No)
15. Previous Address - Street (required; only when applicable)
16. Previous Address - City (required; only when applicable)
17. Previous Address - State (required; only when applicable)
18. Previous Address - ZIP (required; only when applicable)
19. Do you currently have auto insurance? (required; choices: Yes / No)
20. Who is your current auto insurance company? (required; only when applicable)
21. Expiration date of current auto insurance (required; date; only when applicable)
22. Years of continuous auto insurance (required; choices: 0-1 year / 1-2 years / 2-3 years / 3-4 years / 4-5 years / 5 years or more; only when applicable)
23. Have you had any claims in the last 5 years? (required; choices: Yes / No)
24. Vehicles (optional)
25. Drivers (optional)
26. Any driver a member of an Alumni Association? (required; choices: Yes / No)
27. Are there any additional household members? (required; choices: Yes / No)
28. Names of additional household members (required; only when applicable)
29. Dates of birth of additional household members (required; only when applicable)
30. Limits of Liability and Property Damage (required; choices: 100/300/100 / 250/500/250)
31. Uninsured Motorist Limits (required; choices: 15/30 / 25/50 / 50/100 / 100/300 / 250/500 / 500/500)
32. Medical Payments (required; choices: None / $5,000 / $10,000)
33. Per-Vehicle Coverage (optional)
34. Group/association membership (optional; choices: AAA Members / Bank of America Employees / CalCPA / California Medical Association / Costco/Sam's Club Members / Educators / Financial Professionals / Government Employees / Insurance Professionals / Medical Professionals / Mercury Insurance Employees / Pilots / Public Safety Professionals / Scientists and Engineers)
35. AARP member? (required; choices: Yes / No)
36. AARP member number (required; only when applicable)
37. Would you like a quote for renters, home, or condo for the multi-policy discount? (required; choices: Yes / No)
38. What other lines of insurance would you like a proposal for? (required; only when applicable)
39. Also quote the following (required; choices: Earthquake insurance / Flood insurance / Mortgage protection insurance / Other / None)
40. Additional information you want us to have (optional)

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