Our Specialties:
We have excellent markets for preferred drivers with out any major tickets or violations and markets for those who can’t find the coverage through standard markets. Our specialties include:

• Drivers that need SR-22 filings
• New Drivers
• Drivers with 2 and more points

Give us a call and get a quote over the phone. Remember, that there are companies such as Hartford and Safeco that will give you a significant discount if you place your home and auto in one package!

Personal Auto Questionnaire

Applicant’s Information

First Name: Last Name: Street/PO Box: City: State: Zip: Telephone: Email: Fax: Best way to Reach: --- Select item --- Home Phone Business Phone Email Your occupation: Date of Birth: Marital Status --- Select item --- Single Married Domestic Partner Widowed Current Student or Graduate? --- Select item --- Yes No License Suspended or Revoked? --- Select item --- Yes No SR-22 filing required? --- Select item --- Yes No Years Continuously insured --- Select item --- None 1 2 3 4+ How many minor and major violations did you have in the past 3 years --- Select item --- None 1 2 3 4+ What's your driver license? What state was your driver license from? How many additional drivers shall be on a policy --- Select item --- None 1 2 3 4

Vehicle  Information

How many vehicles do you want to insure? --- Select item --- 1 2 3 4 5 Is garaging location same as mailing address? --- Select item --- Yes No Vehicle's Model Vehicle's Make Vehicle's Year Body Type( i.e passenger car, truck, van) Full VIN Please pick the coverage for this vehicle:   Bodily Injury Liability --- Select item --- $15,000/30,000 $25,000/50,000 $50,000/100,000 $250,000/500,000 Property Damage Liability --- Select item --- 10,000 25,000 50,000 100,000 300,000 500,000 Medical Payments --- Select item --- No coverage 1,000 2,000 5,000 Uninsured/Underinsured Motorist Coverage --- Select item --- $15,000/30,000 $25,000/50,000 $50,000/100,000 $250,000/500,000 Physical Damage Collision Deductible --- Select item --- 250 500 750 1000 Physical Damage Comprehensive Deductible --- Select item --- 1 2 3 4 5

Previous Insurance History

Current Insurance: Yes No If yes: Insurance Company Expiration Date Premium paid last year: I need coverage: --- Select item --- ASAP Next Week Next Month I am shopping How did you hear about us?