Tell us a little about yourself and the coverage you’re looking for.
This quick inquiry helps Omni Insurance Services shop options on your behalf and connect you with the right next steps.

Full Name *

Date of Birth *

Email *

Phone *

Address

Street Address *

City

State

Country

Postal code

If Address is Apartment include unit #

What kind of insurance would you like us to help you shop for: *

Auto Insurance

Home/Renters Insurance

Life Insurance

Business Insurance

If you're interested in other kinds of insurance, please list them below:

Authorization Agreement *

By checking this box, you authorize Omni Insurance Services, LLC (OIS) to act as your insurance broker to obtain quotes and gather information from various insurance providers on your behalf. This authorization allows OIS to shop for the coverage options you have requested, but does not permit OIS to purchase or bind any coverage without your explicit consent.

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. Text HELP to (814) 520-6606 for assistance. You can reply STOP to unsubscribe at any time.

Let's get to know you better with a few more questions:

Gender *

Marital Status *

What industry do you work in? *

What is your occupation? *

Education Level: *

Thank you for allowing Omni Insurance Services, LLC to help you find the coverages you need. To help ensure we provide you with the best options, please answer the ten (10) questions below.

1. Are you currently employed?

2. Do you own or rent your home or apartment?

3. How many vehicles would you like to insure?

4. How many of these vehicles do you fully own and have the title to?

5. If you were to total up the value of everything you own (home, cars, savings, etc.), what would that amount be?

6. How much money would you like to leave for your family or loved ones?

7. How much money would you like to leave to charity/charitable associations?

8. Do you own a business?

9. Can you make decisions about the types of insurances that are purchased at your job?

10. Do you have health insurance coverage?

Tell us a little about yourself and the coverage you’re looking for. This quick inquiry helps Omni Insurance Services shop options on your behalf and connect you with the right next steps.

Tell us a little about yourself and the coverage you’re looking for.
This quick inquiry helps Omni Insurance Services shop options on your behalf and connect you with the right next steps.