You may contact us anytime via phone or email, or by filling out  this quote sheet.  We will make every effort to respond to your questions within 24 hours.
Lee Financial & Insurance Agency, Inc.
An Independent Agent
(405) 843-6427
We are licensed to serve Oklahoma

* This field can not be left  
   blank
Full Name *
Date of Birth*
SSN
Driving License # *
 Marital Status*
Home Address *
Do you own this house?*
Yes
No
Phone #*
Best Time To Call
Fax #
Email*
# Violation ticket*
(past 3 year)
 # At fault accident*
(past 3 year)
Driver 1
Other Drivers Info
Driver 2
Driver 3
Full Name *
SSN
Driving Lic. #*
Date of Birth*
Marital Status*
# Violation ticket - past 3 year*
# At fault accident - past 3 year*
Vehicle Info
Vehicle 2
Vehicle 1
 Vehicle 3
 Vehicle 4
 Vehicle 5
Year Built*
Make / Brand*
Model*
# of Cylinder*
# of Doors*
Anti-Lock Break
Alarm System
VIN #*
Coverage Info
Bodily Injurly
All vehicles carry the same limits of liability
All vehicles carry the same limits of liability
Property Damage
Uninsured / Underinsured Motorist       All vehicles carry the same coverage
Medical          All vehicles carry the same medical coverage
Towing     Cover all insured vehicles
Rental        Cover all insured vehicles
Vehicle 1
Vehicle 3
 Vehicle 4
Vehicle 2
Vehicle 5
Collision
Deductible
Comprehensive
Deductible
Current Coverage & Policy
Insurance Company Name
Current Coverage
How long with  this company
Expiration Date
Premium
Comments, Questions, Information Requested: