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Personal Insurance Quote

  1. Home
  2. Personal Insurance Quote
Personal Insurance QuoteBrendan Maun2022-07-22T18:22:30-07:00

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Thank you for your interest in receiving a quote from NEXA Insurance Services. This form should only take about 5 minutes to complete. Don't worry if you don't have everything. You can always click the "Save and continue later" button below. We'll email you a private link to pick up where you left off.
Types of Insurance*
Name*
Can we text you?*

Current Address

Current Mailing Address*
Current Physical Address*

Primary Applicant

Date of Birth*
Motorcycle Endorsement?
Is there a Co-Applicant?

Co-Applicant

Co-Insured Name*
Co-Insured Date of Birth*
Co-Insured Motorcycle Endorsement?

Property Information

Property Address*
Are there multiple dwellings on this property?
Is this a New Purchase?
Purchase Date
Format mm/dd/yyyy
Additional Property Coverage Interests
Have Dogs?
Is home newly built?

Newly Built Home Information

Home Currently Under Construction?*
Has Wood Burning Stove?*
Has Fireplace?*
Has In-Ground Pool?*

Additional Drivers

Driver 1 Information

1. Driver Name*
1. Driver Date of Birth*

Driver 2 Information

2. Driver Name*
2. Driver Date of Birth*

Driver 3 Information

3. Driver Name*
3. Driver Date of Birth*

Driver 4 Information

4. Driver Name*
4. Driver Date of Birth*

Vehicles

Vehicle 1

1. Ownership

Vehicle 2

2. Ownership

Vehicle 3

3. Ownership

Vehicle 4

4. Ownership

Vehicle 5

5. Ownership

Vehicle 6

6. Ownership

Special Motorcycle Coverages

Enhanced Injury Protection
Physical Damage
Roadside Assistance
Carried Contents
Transport Trailer Coverage?

Boat Information

This is the ID number assigned to your boat by the state.
Insure the Trailer?

Umbrella Coverage Information

Any drivers under age 25?
Any drivers over age 75?

Life Insurance

Does Primary Applicant Have a Current Life Policy?
Feet and Inches
Pounds (lbs)
Does Co-Insured Want Life Insurance?
Does Co-Insured Have a Current Life Policy?
Feet and Inches
Pounds (lbs)

Wrapping Up

MM slash DD slash YYYY
Drop files here or
Max. file size: 10 MB.
    Consent*
    Like most insurance agencies, we use information from you and other sources, such as your driving and claims histories, insurance score, and other factors to calculate an accurate rate for your insurance. New or updated information may be used to calculate your renewal premium.
    This field is for validation purposes and should be left unchanged.

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    NEXA Insurance Services

    28202 Cabot Road
    Suite 300,
    Laguna Niguel, California 92677
    Phone: 949-610-3444
    Email: bmaun@1nexa.com

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