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Contact info

  • PO Box 5217
    Huntington, CA 92615
    Phone:
    714-593-6414
    Fax:
    714-593-6104
    Email:

Personal Auto Insurance
Road accidents can be traumatic. With Automobile Insurance, you help prepare yourself financially in the event of collision, theft, fire and other accidents involving your car.
* =Required Fields
Primary Insured
   
* First Name * Last Name
*Gender
Age
Occupation
* Street
* City
State
*Zip Code
*Home Phone
*Business Phone
*Email Address
Present Insurance Company
* Marital Status  
*Yrs Licensed
*Annual Mileage
Last 3 years
*Tickets
*At fault accidents
*Major Violations
DUI last 7 years
 
Additional Drivers
Driver 1
Name
Gender
Age
Occupation
Relationship To Primary
Marital Status
Yrs Licensed
Annual Mileage
LAST 3 YEARS
Tickets
At fault accidents
Major Violations
DUI last 7 years
Driver 2
Name
Gender
Age
Occupation
Relationship To Primary
Marital Status
Yrs Licensed
Annual Mileage
LAST 3 YEARS
Tickets
At fault accidents
Major Violations
DUI last 7 years
Driver 3
Name
Gender
Age
Occupation
Relationship To Primary
Marital Status
Yrs Licensed
Annual Mileage
LAST 3 YEARS
Tickets
At fault accidents
Major Violations
DUI last 7 years
Driver 4
Name
Gender
Age
Occupation
Relationship To Primary
Marital Status
Yrs Licensed
Annual Mileage
LAST 3 YEARS
Tickets
At fault accidents
Major Violations
DUI last 7 years
 
About The Cars
Vehicle 1
*Year

*Make
*Model
*Miles To Work (one way)
Anti-Lock Brakes No Yes
*Protective Devices 
VIN
Primary Driver
Annual Mileage
Vehicle 2
Year

Make
Model
Miles To Work (one way)
Anti-Lock Brakes No Yes
Protective Devices 
VIN
Primary Driver
Annual Mileage
Vehicle 3
Year

Make
Model
Miles To Work (one way)
Anti-Lock Brakes No Yes
Protective Devices 
VIN
Primary Driver
Annual Mileage
Vehicle 4
Year

Make
Model
Miles To Work (one way)
Anti-Lock Brakes No Yes
Protective Devices 
VIN
Primary Driver
Annual Mileage
 
Limits of Liability
Vehicle 1
*Bodily Injury  
*Property Damage  
*UM Bodily Injury  
*UM Property Damage
Medical Payments  
Vehicle 2
Bodily Injury  
Property Damage  
UM Bodily Injury  
UM Property Damage
Medical Payments  
Vehicle 3
Bodily Injury  
Property Damage  
UM Bodily Injury  
UM Property Damage
Medical Payments  
Vehicle 4
Bodily Injury  
Property Damage  
UM Bodily Injury  
UM Property Damage
Medical Payments  
 
Deductibles
Vehicle 1
*Comprehensive  *Collision 
Vehicle 2
Comprehensive    Collision 
Vehicle 3
Comprehensive    Collision 
Vehicle 4
Comprehensive    Collision 
 
Additional Endorsements

Towing

Loss of Use (Rental Car)

Glass Buyback
($100 Deductible)

SR-22 Filing Needed

 
Comments
* Enter Security Code:  
   
 
 

 

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