Shopping for your own policy instead? Get a personal quote →

Submit a customer referral

For partner businesses. Send us the customer's details and we'll have a quote and binder back to you fast — usually within the hour during business hours. Attach the paperwork you already have and you can skip most of the typing.

Your information

So we know who to send the quote back to.

Company *

Your name *

Your cell *

Your email *

We reply directly to this address.

Customer information

The person who needs the policy. Attaching paperwork under Documents (Section 5) makes this and the next two sections optional.

First name *

Last name *

Phone *

Email *

Vehicle

The VIN alone is usually enough.

VIN *

0/17

No letters I, O, or Q appear in a VIN.

Year optional

Make optional

Model optional

Delivery / effective date *

When the customer takes the car — coverage must be active by then.

How it's being paid for

Lenders and lessors have to be listed on the policy.

Finance Bank or credit union loan Lease Leasing company on title Cash Paid in full, no lienholder

Documents optional

Buyer's order, registration, current declarations page, driver's license — photos are fine. Attach one and Sections 2–4 above become optional — we'll pull those details from the documents instead.

Tap to add photos or files

PDF, JPG, PNG, HEIC, DOC — up to 10 files, 4 MB each. Photos are shrunk automatically.

Anything else

Trade-in, additional drivers, prior carrier, urgency.

Goes straight to the JR Orenstein Agency referral desk.

Submit a customer referral

Your information

Customer information

Vehicle

How it's being paid for

Documents optional

Anything else

Referral received