Personal Auto Quote

Quote

Request an insurance quote for your personal automobile.

Click to open/close each section and enter required information. Time to complete: less than 5 minutes

Step # 1 of 7 - Personal and contact information

COMPLETE SECTION # 1 - PERSONAL INFORMATION

Your contact information will be kept private and secure.

What is your name: *

Address: *

S.S.N.:

Contact telephone number: *

Email address:

Step # 2 of 7 - Current insurance information

COMPLETE STEP # 2 - CURRENT INSURANCE INFORMATION

Current insurance company: *

What is your current premium (optional):

Current policy expiration date: *

Step # 3 of 7 - Liability & Coverage - Protection

What are your current bodily injury & property damage damage limits: *

What do I want my policy to pay

This pays for bodily injury or property damage for which you become legally responsible due to an auto accident. For example, you were in an accident that was your fault and there was more than say $300,000 in damages, what is the amount you would want your policy to pay?

What are your current uninsured/underinsured motorists limits: *

What happens if the other person doesn't have insurance?

Uninsured/underinsured Motorist coverage pays for bodily injury to you or your passengers involving a driver who has little or no liability coverage.

Do you have Medical Insurance?: *

What is your comprehensive deductible: *

What is comprehensive coverage

Some of the coverages provided under comprehensive include theft, glass breakage, fire, windstorm, hail, water, falling objects, vandalism, explosion, or hitting a bird or animal. You may consider higher deductibles to lower your premiums.

What is your collision deductible: *

What is collision coverage

Collision covers damage to your car when your car hits, or is hit by, another vehicle, or other object. It pays to fix your vehicle less the deductible you choose. To keep your premiums low, select as large a deductible as you feel comfortable paying out of pocket.

Do you have towing coverage: *

Should I have towing coverage

When you have this coverage the insurer will pay reasonable expenses incurred for towing your car to the nearest place where necessary repairs can be made during regular business hours, towing your car out if it is stuck on or next to a public street or highway,etc.

Do you have rental car coverage: *

Do I need coverage for rental cars

Rental Reimbursement coverage provides a specified amount for you to rent a vehicle while your covered auto is being repaired or replaced after a loss covered under Comprehensive or Collision.

Step # 4 of 7 - Driver information

COMPLETE STEP # 5 - DRIVER INFORMATION

Driver # 1 name: *

Driver # 1 date of birth: *

Driver # 1 license number:

Driver # 1 gender: *

Driver # 1 marital status: *

Driver # 1 had any accidents in the past 5 years: *

Driver # 1 past 5 years has license been suspended or revoked: *

Click here to enter information for driver # 2

Driver # 2 name:

Driver # 2 date of birth:

Driver # 2 license number :

Driver # 2 gender:

Driver # 2 marital status:

Driver # 2 had any accidents in the past 5 years:

Driver # 2 past 5 years has license been suspended or revoked:

If you have any additional drivers in the household please list the following in the comment box below: Name, Birthdate, & Drivers License #.

Step # 5 of 7 - Vehicle Information

Vehicle # 1 make: *

type

Vehicle # 1 year: *

type

Vehicle # 1 model: *

Vehicle # 1 Vehicle Identification Number (VIN): *

Vehicle # 1 distance (one way) to work or school: *

Vehicle # 1 ownership: *

Vehicle # 1 registration: *

Click here to enter information for vehicle # 2

Vehicle # 2 make:

type

Vehicle # 2 year:

type

Vehicle # 2 model:

Vehicle # 2 Vehicle Identification Number (VIN):

Vehicle # 2 distance (one way) to work or school:

Vehicle # 2 ownership:

Vehicle # 2 registration:

Click here to enter information for vehicle # 3

Vehicle # 3 make:

type

Vehicle # 3 year:

type

Vehicle # 3 model:

Vehicle # 3 Vehicle Identification Number (VIN):

Vehicle # 3 distance (one way) to work or school:

Vehicle # 3 ownership:

Vehicle # 3 registration:

Click here to enter information for vehicle # 4

Vehicle # 4 make:

type

Vehicle # 4 year:

type

Vehicle # 4 model:

Vehicle # 4 Vehicle Identification Number (VIN):

Vehicle # 4 distance (one way) to work or school:

Vehicle # 4 ownership:

Vehicle # 4 registration:

Step # 6 of 7 - Protection Review

In order to properly protect your assets, its important that we have complete information about your total account. Some of the questions determine if you are eligible for premium discounts.

Provide information on the following:

	Yes	No	NA
Do you have a home?
Do you have rental property?
Do you have household members away at school?
Do you have Life Insurance?
Do you have any recreational vehicles such as boats or snowmobiles?
Do you have coverage for Identity Theft Restoration?
Do you have a Disability or Long Term Care policy?
Do you own a business?

COMPLETE SECTION # 7 - PROTECTION REVIEW

When does your home policy expire:

Who is your current company for homeowners insurance:

Step # 7 of 7 - Comments and approval

COMPLETE SECTION # 8 - COMMENTS & APPROVAL

Comments and questions (optional):

How did you hear about us: *

I accept the terms and conditions: *

Yes

Please enter your initials to sign this quote: *

Customer name or code:

Thanks for providing this information . If we need to contact you for additional information, we will send you a message through the secure Message Center. You can view a copy of this request by clicking on File Cabinet. You will receive an email confirming this request made on Monday, February 6, 2012 - 3:07am.

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Personal Auto Quote

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