Claim Consultation in Lincoln, NE | Vault Insurance & Risk Management

We suggest getting an estimate in the event of a loss.

Name(Required)

First Last

Email(Required)

Date of Loss

MM slash DD slash YYYY

Please describe what happened as best you can.

Please upload any files or images you have regarding this potential claim.

Drop files here or

Max. file size: 5 MB, Max. files: 5.

Consent(Required)

I am requesting a claim consultation

I understand that submitting this form does NOT constitute filing a claim with my insurance carrier. For a claim to be filed I need to contact my carrier directly.

Please complete the form below for a quote.

Step 1 of 4

25%

What Kind of Insurance Are You Interested In?(Required)

Home

Auto

Motorcycle

Powersports

Life

Boat

Renters Insurance

Personal Liability Umbrella

Preferred Agent(Required)

How Did You Find Us?(Required)

Other(Required)

Why Are You Looking For Quotes? (Select At Least One)(Required)

I've Had Issues With My Last Agent

I Shop Around Each Year

I've Had Previous Claims Issues

I've Had Billing Frustrations

I'm Curious If I Can Get Better Rates

I Don't Know If I Have Enough Coverage

Other

Other(Required)

First Name(Required)

Last Name(Required)

Your Email(Required)

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

Are You Single or Married?(Required)

Single

Married

Spouse First Name(Required)

Spouse Last Name(Required)

Your Phone Number(Required)

Driver Information (click the Plus icon to add as many drivers as needed)(Required)

ALL DRIVERS IN HOUSEHOLD MUST BE LISTED

Full Driver Name

License Number

Date of Birth

State Licensed

SMS Consent

By submitting a quote request you consent to receive text messages regarding your quotes. If at any time you do not want to be texted, respond with STOP or give us a call. Message and data rate charges may apply.

Powersports

Year(Required)

Make(Required)

Model(Required)

VIN #(Required)

Boat Insurance

Engine Size(Required)

Hull #(Required)

Maximum Speed(Required)

Auto Insurance

Vehicle Information(Required)

Please click on the "+" icon to add more vehicles.

VIN # - Required

Full Coverage or Liability

Year Purchased

If you want full coverage, what deductible would you like?(Required)

$500

$1000

Other

Current Insurance Company

Current Liability Limits If Known (Example: 100/300/100)

Do you use your vehicle for any type of delivery service (example: Doordash, pizza, Uber, etc)?(Required)

Yes

Home Insurance

Is this a new purchase?(Required)

Yes

If this is a new purchase, what is the address?

What is the purchase price?(Required)

When was the roof last completed?(Required)

When was the furnace last updated?(Required)

Do you have a pool or trampoline?

Pool

Trampoline

Neither

Life Insurance

Do you use tobacco?(Required)

Yes

How much coverage are you needing?(Required)

$100,000

$250,000

$500,000

$750,000

$1 million

Other

Other(Required)

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Are you ready to save time, aggravation, and money? The team at Vault Insurance & Risk Management is here and ready to make the process as painless as possible. We look forward to meeting you!

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