Personal Auto Insurance Quote

Please fill in all information accurately.

Personal Auto Form

Personal Information

Name
Address
City

State

Zip

Day Phone

Evening phone

Best time to call
AM
PM
E-mail address
Marital Status
Married
Single

Current Auto Insurance

Company

Policy Expiration Date

Premium $

Term
6 Months One Year Other

Vehicle Information

Year
Make
Model
Body Type
Vehicle ID No. (VIN)
Year
Make
Model
Body Type
Vehicle ID No. (VIN)
Year
Make
Model
Body Type
Vehicle ID No. (VIN)
Year
Make
Model
Body Type
Vehicle ID No. (VIN)

Desired Coverage

Liability limit for all covered vehicles

Bodily Injury

Property Damage

Deductibles and other coverages

Vehicle #

Comprehensive Deductible

Collision Deductible

Towing

Loss of Use

1

Yes

Yes

2

Yes

Yes

3

Yes

Yes

4

Yes

Yes

Driver Information

Name

DL #

State

Year Licensed

Relation

Date of Birth

Sex

Male

Female

Marital Status

Married

Single

List any and all tickets and accidents in the last three years (include dates):

Name

DL #

State

Year Licensed

Relation

Date of Birth

Sex

Male

Female

Marital Status

Married

Single

List any and all tickets and accidents in the last three years (include dates):

Name

DL #

State

Year Licensed

Relation

Date of Birth

Sex

Male

Female

Marital Status

Married

Single

List any and all tickets and accidents in the last three years (include dates):

Name

DL #

State

Year Licensed

Relation

Date of Birth

Sex

Male

Female

Marital Status

Married

Single

List any and all tickets and accidents in the last three years (include dates):

Additional Information

Please provide any other additional information

Things to know

1. Buy a "Low Profile" Car. Before you buy a new or used car, check into insurance costs. Cars that are expensive to repair, or that are favorite targets for thieves, have much higher insurance costs.

2. Consider Insurance Cost When Making a Move. Costs tend to be lowest in rural communities and highest in cities where there is more traffic congestion.

3. Inquire About Other Discounts. Some insurers offer discounts for having multiple cars insured with them, anti-theft devices, good driving records, driver training courses, AAA group membership, passive restraints, use of public transit, low mileage, and for drivers over 65.

4. Ask for Higher Deductibles. Deductibles represent the amount of money you pay before you make a claim. By requesting higher deductibles on collision and comprehensive (fire and theft) coverage, you can lower your costs substantially. For example, increasing your deductible from $500 to $1,000 could reduce your collision and comprehensive cost by 15% to 30%.

5. Drop Collision and/or Comprehensive Coverage on Older Cars. It may not be cost-effective to have collision or comprehensive coverage on cars worth less than $3,000 because any claim you make would not substantially exceed annual cost and deductible amounts. Auto dealers and banks can tell you the worth of your car.

6. Take Advantage of Low Mileage Discounts. Some companies offer discounts to motorists who drive less than a predetermined number of miles per year.