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Please fill out the entire form below. Questions with *asterisks are required to submit the quote.

Do you currently have auto insurance? * YES NO

If yes, what is the name of your current insurance company?

Current bodily injury liability coverage?

Driver #1

Driver 1 First Name on License * MI*Last Name*

What state issued the license? * Drivers License #*

Date of Birth (ex: 01/01/1970) * Marital Status*

Sex * Male Female

Current Work Status * Occupation*

Driver #2 (If Applicable)

Driver 2 First Name on License M :

(2) Last Name:

Which state issued your license? Drivers License Number

Birth Date (ex 01/01/1970) Marriage Status :

Sex (M, F) : Male Female

Work Status : Current Occupation :

Additional Drivers

If more than two drivers live in your household, please include their names and ages here.

Vehicle #1

Make (example: Honda) * Vehicle Year :*

Model (example: Accord) *

Vehicle #2

Make (example: Ford) Year

Model (example: Explorer)

Additional Vehicles

If you have more than two vehicles, please include the make, model and year here.

Contact Information

Street: * Apt/Suite #

City : * Zip :*

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Basic information you should know
about your Auto Insurance Policy

What is Auto insurance?
What are the 6 parts of a standard Auto policy?
How to protect yourself against Uninsured Motorist?

What is auto insurance?

Auto insurance protects you against financial loss if you have an accident. It is a contract between you and the insurance company. You agree to pay the premium and the insurance company agrees to pay your losses as defined in your policy.

Auto insurance provides property, liability and medical coverage:

Property coverage pays for damage to or theft of your car.

Liability coverage pays for your legal responsibility to others for bodily injury or property damage.
Medical coverage pays for the cost of treating injuries, rehabilitation and sometimes lost wages and funeral expenses.

An auto insurance policy is comprised of six different kinds of coverage. Most states require you to buy some, but not all, of these coverages. If you're financing a car, your lender may also have requirements.

Most auto policies are for six months to a year. Your insurance company should notify you by mail when it’s time to renew the policy and to pay your premium.

What are the 6 parts of a standard Auto Insurance Policy?

Bodily Injury Liability

This coverage applies to injuries that you, the designated driver or policyholder, cause to someone else. You and family members listed on the policy are also covered when driving someone else’s car with their permission.

It’s very important to have enough liability insurance, because if you are involved in a serious accident, you may be sued for a large sum of money. Definitely consider buying more than the state-required minimum to protect assets such as your home and savings.
Medical Payments or Personal Injury Protection (PIP)

This coverage pays for the treatment of injuries to the driver and passengers of the policyholder's car. At its broadest, PIP can cover medical payments, lost wages and the cost of replacing services normally performed by someone injured in an auto accident. It may also cover funeral costs.
Property Damage Liability

This coverage pays for damage you (or someone driving the car with your permission) may cause to someone else's property. Usually, this means damage to someone else’s car, but it also includes damage to lamp posts, telephone poles, fences, buildings or other structures your car hit.
Collision

This coverage pays for damage to your car resulting from a collision with another car, object or as a result of flipping over. It also covers damage caused by potholes. Collision coverage is generally sold with a deductible of $250 to $1,000—the higher your deductible, the lower your premium. Even if you are at fault for the accident, your collision coverage will reimburse you for the costs of repairing your car, minus the deductible. If you're not at fault, your insurance company may try to recover the amount they paid you from the other driver’s insurance company. If they are successful, you'll also be reimbursed for the deductible.
Comprehensive

This coverage reimburses you for loss due to theft or damage caused by something other than a collision with another car or object, such as fire, falling objects, missiles, explosion, earthquake, windstorm, hail, flood, vandalism, riot, or contact with animals such as birds or deer.

Comprehensive insurance is usually sold with a $100 to $300 deductible, though you may want to opt for a higher deductible as a way of lowering your premium.

Comprehensive insurance will also reimburse you if your windshield is cracked or shattered. Some companies offer glass coverage with or without a deductible.
Uninsured and Underinsured Motorist Coverage
This coverage will reimburse you, a member of your family, or a designated driver if one of you is hit by an uninsured or hit-and-run driver.

Underinsured motorist coverage comes into play when an at-fault driver has insufficient insurance to pay for your total loss. This coverage will also protect you if you are hit as a pedestrin.

How to Protect yourself from Uninsured Motorist?

All states have laws that require drivers to show proof of their financial ability to pay personal injury or property damage to others in the event of an accident. Most motorists satisfy this requirement by purchasing insurance -- but many cannot afford or ignore this legal and financial obligation. This means that responsible drivers who carry insurance must bear the burden of paying for damages to their vehicle caused by someone who has no insurance at all.

The Insurance Information Network of California offers the following tips on how to protect yourself against uninsured motorists, what to do if an uninsured motorist hits you and what steps to take if you are involved in an accident.

CONSIDER BUYING UNINSURED MOTORIST COVERAGE

Insurance agents and companies are required by law to offer uninsured motorist coverage when you buy auto insurance. Uninsured motorist coverage pays for bodily injuries caused by an uninsured motorist or a hit and run driver who is legally responsible for the accident. In most states, it also applies to injuries caused by a motorist whose insurance company is insolvent.

This coverage applies to you, family members and guests in the car. It also provides protection when you are in someone else's car or if you are hit while walking. Your insurance company will pay for damages to injured persons up to the minimum limits prescribed by the financial responsibility laws of your state. Higher limits may be available.

You may also consider buying underinsured motorist coverage which pays you for damages caused by a motorist who does not have enough liability insurance to fully cover your damages.

PRACTICE DEFENSIVE DRIVING

It's our responsibility to exercise caution on the road to help prevent any accidents. You can protect yourself from erratic drivers by concentrating on the following:

Other drivers (give that weaving motorist space)
The road (watch out for unexpected curves and potholes)
Traffic (allow more following distance during rush hours)
The weather (will the upcoming bridge be icy?)
Your vehicle (you can't rely on a car that's not in good running condition)
The light (can other drivers see you at night?)

Also avoid driving when you are angry, sleepy, sick or otherwise distracted. When you are driving at night, take extra precaution as the nighttime traffic death rate is almost 10 percent higher than the daytime rate.

IF AN UNINSURED MOTORIST HITS YOU
Insurance agents and brokers strongly advise that you get the license plate number of the vehicle, name and drivers license number of the driver and the names of any witnesses. Notify your agent about this information immediately so that they can start processing your claim.
If you don't have uninsured motorist coverage, you may be able to use the collision coverage of your policy to pay for damages. If it seems unlikely that the uninsured motorist will pay for any damages, your last resort would be a lawsuit that can be expensive.

WHAT TO DO IF YOU ARE IN AN ACCIDENT

Step 1: Call for medical help if anyone is injured.
Step 2: Call the police and do not leave the scene of the accident until they arrive.
Step 3: Get the names, addresses, phone numbers, insurance company numbers and drivers licenses of all parties involved in the accident (witnesses and passengers). Also get the year, make, model and license plate number of all cars.
Step 4: Write down the details of the accident--time of day, weather and road conditions, and driving speed. You may also want to sketch a diagram of the site of the accident including street names, traffic signals and the direction of the cars. If you have a camera, you should take pictures.
Step 5: Notify your insurance agent or company immediately. Get a copy of the police report and save copies of everything.

WHAT NOT TO DO IF YOU ARE IN AN ACCIDENT
Move any injured persons.
Apologize for the accident.
Tell any party how much insurance you carry. You should only discuss what types of coverage you have.
Accept any money. If you do, you forfeit your right to file any claims.
Agree to forget about the accident. Later on, the other person may file a lawsuit against you.

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