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   800-227-0580               727-797-5193                 Fax 727-726-7875

Alley, Rehbaum & Capes is one of Tampa Bays oldest and most established Agencies. We represent A+ rated companies so we can shop the market to get you the best insurance value.

ARC has a very experienced in - house claims department. We will be your advisor and mobilize all our considerable resources to help you get a prompt, fair settlement in the event you have a claim. We understand your needs and we want to be your one stop Agency.

Call today for a free quote and evaluation 727-797-5193 /  800-227-0580. 
You may also leave us a note or fill in the form below for a quick quote!

Remember, we insure Florida residents only!

Auto E-Quote 

Name:           
Email:         	
Address:      	
City/State/Zip:	
Work Phone:    	
Home Phone:    	

Comments and Questions:


Click "Submit" button now
or continue to insurance Quote form:
   
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   INSURANCE QUOTE FORM

Please list the Coverage and Limits
you are currently carrying.

You may leave any of these blank if not applicable:

Your Auto or Truck Information
Bodily Injury Liability:           
Property Damage Liability:	       
Uninsured Motorist:	   Stacked  Non-Stacked
Uninsured Motorist:	           
Personal Injury Protection:	     
Additional Personal Injury Protection: 
Medical Payments:		       

Comprehensive Deductible:	     
Collision Deductible:		     
Do you want Towing Coverage?		Yes  No
Do you want Rental Reimbursement?	Yes  No

Fill out as many Vehicle and Driver forms as needed.

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VEHICLE #1             
Year:			      
Make and Model:		
Currently Insured?      Yes  No 
Number of Doors:	
Anti-Lock Brakes?  	Yes  No
Airbags:		
Alarm?  		Yes  No
Miles Driving to Work (One Way):   
Is this vehicle used for any business purposes?
Yes  No
Who is the Primary Driver?:


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VEHICLE #2             
Year:			      
Make and Model:		
Currently Insured?      Yes  No 
Number of Doors:	
Anti-Lock Brakes?  	Yes  No
Airbags:		
Alarm?  		Yes  No
Miles Driving to Work (One Way):   
Is this vehicle used for any business purposes?
Yes  No
Who is the Primary Driver?:


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VEHICLE #3             
Year:			      
Make and Model:		
Currently Insured?      Yes  No 
Number of Doors:	
Anti-Lock Brakes?  	Yes  No
Airbags:		
Alarm?  		Yes  No
Miles Driving to Work (One Way):   
Is this vehicle used for any business purposes?
Yes  No
Who is the Primary Driver?:


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DRIVER #1
Name 		        
Date of Birth 	        
Gender		        M  F 
Marital Status          
DL# and State           
SS#                     
Years licensed          
Homeowner               Yes No
Relationship to Insured 
How many drivers in household 

Please explain all claims and traffic
violations filed in past 3 years:


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DRIVER #2
Name 		        
Date of Birth 	        
Gender		        M  F 
Marital Status          
DL# and State           
SS#                     
Years licensed          
Homeowner               Yes No
Relationship to Insured 
How many drivers in household 

Please explain all claims and traffic
violations filed in past 3 years:

---------------------------------------------
DRIVER #3
Name 		        
Date of Birth 	        
Gender		        M  F 
Marital Status          
DL# and State           
SS#                     
Years licensed          
Homeowner               Yes No
Relationship to Insured 
How many drivers in household 

Please explain all claims and traffic
violations filed in past 3 years:



You may now:

   
 
 
 

Homeowners E-Quote

Florida Residents only
(Renters, Mobil Home, Condo-Owners Too !)


Personal Information 
Name:          	
Email:         	
Address:     	
City/State/Zip:	
Work Phone:    	
Home Phone:    	

Comments and Questions:


Click "Submit" button now
or continue to Insurance Quote Form:
 

------------------------------------------------

INSURANCE QUOTE FORM

What type of insurance quote do you need?
	 	 

Property Address:
City/State/Zip:	 
County:	 	 

Effective Date Needed:
	 	 

Previous Insurance:Yes  No
		 If yes, Name of Company:
    		 
		 If yes, Expiration Date:
    		 

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House/Dwelling Value:(not applicable to Renters, Condos)
		 
Is your Residence rented to others?Yes  No

How many months per year is the Residence occupied?
Use of Home:		 
Use of Home:		 

Distance to Open Water:  
Distance to Fire Hydrant:
Distance to Fire Station:
Year Built:		 
Living Area (Sq.Ft.):		
Construction Type: 	 Masonry Frame
Central Heat & Air?	 Yes  No
Roof Material:		 
Garage/Carport: (Check all that apply)
Carport                1 Car Garage Attached
1 Car Garage Detached  2 Car Garage Attached
2 Car Garage Detached  3 Car Garage Attached

Is your House on Stilts? Yes  No
Safety Features: (Check all that apply)
Smoke Detectors        Local Alarm
Central Alarm          Indoor Sprinklers
Storm Shutters

Does the Residence have a Pool? Yes  No
(Do not include clubhouse or common area pools.)
If yes, is it screened or fenced?:  Yes  No
(Fence height at least 4 feet)
Do you have any dogs? 
		  Yes  No
		 If yes, what breed?: 
    		  

Deductible Amount 

Liability Limit   

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Renters/Condo Unit-owners Only -  Value of Contents
		
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Loss Assessment Coverage (Condo Only)   

Are the Outside Walls of your Condo
insured by the Association? (Condo Only)  Yes  No
Value of Interior/Fixtures of condo-unit (not 
covered by the Association): 


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Are you interested in buying flood insurance?Yes No
(An agent will contact you regarding the detailed
information required to quote a flood insurance policy).

Additional Coverages or Information:


You may now:
Alley, Rehbaum & Capes
2433 Gulf to Bay Blvd.
P.O. Box 4620
Clearwater, Florida 33758