AUTO INSURANCE QUOTE

We have over 10 companies to choose from for the most extensive coverage for your entire family and all your vehicles.  Cars, trucks, campers, trailers, motorhomes, motorcycles, and classic autos can all be quotes in a matter of minutes.


DUNCAN & ASSOCIATES
AUTO INSURANCE QUOTE FORM

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If other:
 
Driver #1
Name:
Phone Number:
Address:
Social Security Number: (why we need this information)
Date of Birth:
Drivers License Number:
State:
How long have you lived in the area?
Do you:
Marital Status: (if married, spouse information is required)
   
Driver #2  
Name:
Social Security Number: (why we need this information)
Date of Birth:
Drivers License Number:
State:
Are there any other drivers in the household? Yes  No
   
Driver #3  
Name:
Social Security Number: (why we need this information)
Date of Birth:
Drivers License Number:
State:
If a student, is the GPA 3.0 or better?
Is the driver a resident of your household?
   
Driver #4  
Name:
Social Security Number: (why we need this information)
Date of Birth:
Drivers License Number:
State:
If a student, is the GPA 3.0 or better?
Is the driver a resident of your household?
   
Driver #5  
Name:
Social Security Number: (why we need this information)
Date of Birth:
Drivers License Number:
State:
If a student, is the GPA 3.0 or better?
Is the driver a resident of your household?
   
Driver #6  
Name:
Social Security Number: (why we need this information)
Date of Birth
Drivers License Number:
State:
If a student, is the GPA 3.0 or better?
Is the driver a resident of your household?
   
Have you had continuous insurance coverage for the past 5 years? Yes  No
Who are you currently insured with?
How long have you been insured there?
When does your current policy expire?
Have any drivers in the household had any accidents or claims in the last 5 years? (if yes, answer next three  questions) Yes  No
How many accidents?
Date(s) of accident(s):
Amount paid by company:
   
Vehicle Information for Driver #1  
Year:
Make:
Model:
Vin #: (found on registration)
Does the vehicle have the following:  
4 wheel drive: Yes  No
ABS Brakes: Yes  No
Number of air bags:
Anti-Theft Device: Yes  No
   
Is there any existing damage to the vehicle? Yes  No
Do you belong to Triple A? Yes  No
Do you need Auto Loan Coverage? Yes  No
How many miles do you drive one way to work?
What are your current limits?
   
Vehicle Information for Driver #2  
Year:
Make:
Model:
Vin #: (found on registration)
Does the vehicle have the following:  
4 wheel drive: Yes  No
ABS Brakes: Yes  No
Number of air bags:
Anti-Theft Device: Yes  No
   
Is there any existing damage to the vehicle? Yes  No
Do you belong to Triple A? Yes  No
Do you need Auto Loan Coverage? Yes  No
How many miles do you drive one way to work?
What are your current limits?
   
Vehicle Information for Driver #3  
Year:
Make:
Model:
Vin #: (found on registration)
Does the vehicle have the following:  
4 wheel drive: Yes  No
ABS Brakes: Yes  No
Number of air bags:
Anti-Theft Device: Yes  No
   
Is there any existing damage to the vehicle? Yes  No
Do you belong to Triple A? Yes  No
Do you need Auto Loan Coverage? Yes  No
How many miles do you drive one way to work?
What are your current limits?
   
Vehicle Information for Driver #4  
Year:
Make:
Model:
Vin #: (found on registration)
Does the vehicle have the following:  
4 wheel drive: Yes  No
ABS Brakes Yes  No
Number of air bags:
Anti-Theft Device: Yes  No
   
Is there any existing damage to the vehicle? Yes  No
Do you belong to Triple A? Yes  No
Do you need Auto Loan Coverage? Yes  No
How many miles do you drive one way to work?
What are your current limits?
   
Vehicle Information for Driver #5  
Year:
Make:
Model:
Vin #: (found on registration)
Does the vehicle have the following:  
4 wheel drive: Yes  No
ABS Brakes: Yes  No
Number of air bags:
Anti-Theft Device: Yes  No
   
Is there any existing damage to the vehicle? Yes  No
Do you belong to Triple A? Yes  No
Do you need Auto Loan Coverage? Yes  No
How many miles do you drive one way to work?
What are your current limits?
   
Vehicle Information for Driver #6  
Year:
Make:
Model:
Vin #: (found on registration)
Does the vehicle have the following:  
4 wheel drive: Yes  No
ABS Brakes: Yes  No
Number of air bags:
Anti-Theft Device: Yes  No
   
Is there any existing damage to the vehicle? Yes  No
Do you belong to Triple A? Yes  No
Do you need Auto Loan Coverage? Yes  No
How many miles do you drive one way to work?
What are your current limits?

 
 

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