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Vehicle Information
Vehicle Year
--Year--
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Make
--Make--
Model
--Model--
Submodel
--Submodel--
Ownership
Owned
Financed
Leased
Primary use
please select
Commute
Pleasure
Business
Farm
Annual mileage
3000
4000
5000
6000
7000
8000
9000
10000
11000
12000
13000
14000
15000
16000
17000
18000
19000
20000
21000
22000
23000
24000
25000
26000
27000
28000
29000
30000
31000
32000
33000
34000
35000
36000
37000
38000
39000
40000
41000
42000
43000
44000
45000
46000
47000
48000
49000
50000
Night parking garage
No Cover
Carport
Locked
Private
Security system
No Alarm
Alarm
Disabling Device
Audible + Disable
Anti-lock brakers
2 Wheels
4 Wheels
None
Airbags
None
Driver's side only
Dual front airbags
Dual front + side impact
Dual front + side + head
Coverage Information
Coverage Desired
State Minimum
Lower Level
Typical Level
Highest Level
Do you require an SR-22 or Financial Responsibility Statement?
Yes
No
Have you filed for bankruptcy in the past 5 years?
Yes
No
Add an additional driver?
Yes
No
Add an additional auto?
Yes
No
Have you filed recent claims?
Yes
No
Have you had insurance in the past 30 days?
Yes
No
Current insurance company?
Select a carrier
AIG
AIU Insurance
Allied
Allstate County Mutual
Allstate Indemnity
Allstate Insurance
American Alliance Insurance
American Automobile Insurance
American Casualty
American Deposit Insurance
American Direct Business Insurance
American Empire Insurance
American Family Insurance
American Family Mutual
American Financial
American Home Assurance
American Insurance
American International Ins
American International Pacific
American International South
American Manufacturers
American Mayflower Insurance
American Motorists Insurance
American National Insurance
American Premier Insurance
American Protection Insurance
American Service Insurance
American Skyline Insurance Company
American Spirit Insurance
American Standard Insurance - OH
American Standard Insurance - WI
Amica Insurance
Arbella
Associated Indemnity
Atlanta Casualty
Atlantic Indemnity
Auto Club Insurance Company
Blue Cross and Blue Shield
Cal Farm Insurance
California State Automobile Association
Chubb
Citizens
Clarendon American Insurance
Clarendon National Insurance
CNA
Colonial Insurance
Company Not Listed
Continental Casualty
Continental Divide Insurance
Continental Insurance
Cotton States Insurance
Country Insurance and Financial Services
Dairyland County Mutual Co of TX
Dairyland Insurance
Electric Insurance
Erie Insurance Company
Erie Insurance Exchange
Erie Insurance Group
Erie Insurance Property and Casualty
Farm Bureau/Farm Family/Rural
Farmers Insurance
Farmers Insurance Exchange
Farmers TX County Mutual
Fire and Casualty Insurance Co of CT
Firemans Fund
Geico Casualty
Geico General Insurance
Geico Indemnity
GMAC Insurance
Golden Rule Insurance
Government Employees Insurance
Grange
Guaranty National Insurance
Hanover Lloyds Insurance Company
Hartford Accident and Indemnity
Hartford Casualty Insurance
Hartford Fire Insurance
Hartford Insurance Co of Illinois
Hartford Insurance Co of the Southeast
Hartford Omni
Hartford Underwriters Insurance
Health Plus of America
IFA Auto Insurance
IGF Insurance
Infinity Insurance
Infinity National Insurance
Infinity Select Insurance
Integon
Kaiser Permanente
Kemper Lloyds Insurance
Landmark American Insurance
Leader National Insurance
Leader Preferred Insurance
Leader Specialty Insurance
Liberty Insurance Corp
Liberty Mutual Fire Insurance
Liberty Mutual Insurance
Liberty Northwest Insurance
Lumbermens Mutual
Mass Mutual
Mercury
Metropolitan Insurance Co.
Mid Century Insurance
Mid-Continent Casualty
Middlesex Insurance
Midwest National Life
MSI Insurance
Mutual of New York
Mutual of Omaha
National Ben Franklin Insurance
National Casualty
National Continental Insurance
National Fire Insurance Company of Hartford
National Health Insurance
National Indemnity
National Union Fire Insurance of LA
National Union Fire Insurance of PA
Nationwide General Insurance
Nationwide Mutual Fire Insurance
Nationwide Mutual Insurance
Nationwide Property and Casualty
New York Life Insurance
Northwestern Mutual Life
Northwestern Pacific Indemnity
Omni Indemnity
Omni Insurance
Orion Insurance
Pacific Indemnity
Pacific Insurance
Pafco General Insurance
Patriot General Insurance
Peak Property and Casualty Insurance
PEMCO Insurance
Progressive
Progressive Auto Pro
Prudential Insurance Co.
Reliance Insurance
Reliance National Indemnity
Reliance National Insurance
Republic Indemnity
Response Insurance
Safeco
Safeway Insurance
Safeway Insurance Co of AL
Safeway Insurance Co of GA
Safeway Insurance Co of LA
Security Insurance Co of Hartford
Security National Insurance Co of FL
Sentinel Insurance
Sentry Insurance a Mutual Company
Sentry Insurance Group
Shelter Insurance Co.
St. Paul
St. Paul Fire and Marine
St. Paul Insurance
Standard Fire Insurance Company
State and County Mutual Fire Insurance
State Farm County
State Farm Fire and Cas
State Farm General
State Farm Indemnity
State Farm Insurance Co.
State Farm Lloyds Tx
State Farm Mutual Auto
State National Insurance
Superior American Insurance
Superior Guaranty Insurance
Superior Insurance
The Ahbe Group
TICO Insurance
TIG Countrywide Insurance
Travelers Indemnity
Travelers Insurance Company
Tri-State Consumer Insurance
Twin City Fire Insurance
Unicare
United Pacific Insurance
United Security
United Services Automobile Association
Unitrin Direct
USAA Casualty Insurance
USAA General Indemnity
USF and G
Viking County Mutual Insurance
Viking Insurance Co of WI
Windsor Insurance
Woodlands Financial Group
Company Not Listed
Insurance Expiration Date?
month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
year
2012
2011
2010
Years Insured?
Select years insured
Less than 1 year
1-2 years
2-3 years
3-4 years
4-5 years
5 years or more
Driver Information
Date of birth
month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
year
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
Marital status
please select
Single
Married
Divorced
Widowed
Gender
please select
Female
Male
Occupation
please select
Administrative Clerical
Architect
Business Owner
Certified Public Accountant
Clergy
Construction Trades
Dentist
Disabled
Engineer
Homemaker
Lawyer
Manager/Supervisor
Military Officer
Military Enlisted
Minor/NA
Other Non-technical
Other Technical
Physician
Professional Salaried
Professor
Retail
Retired
Retired
Sales, Inside
Sales, Outside
School Techer
Scientist
Self Employed
Skilled/Semi Skilled
Student
Unemployed
Highest education level
please select
Some/No Highschool
High School Diploma
GED
Some College
Associates Degree
Bachelors Degree
Masters Degree
Doctorate Degree
Other Professional Degree
Other Non-Prof. Degree
Trade/Vocational School
Self credit evaluation
Poor
Average
Good
Excellent
Current residence
Own
Rent
Other
Years lived there
Less than 1 year
1-2 years
2-3 years
3-4 years
4-5 years
5 years or more
License status
please select
Active
Suspended
Probation
Probation/Negligence
Restricted
Learner
Temporary
International
Age Licensed ( Years old )
Violation (if any)
None
Child Seat
Failure to Stop
Illegal U-turn
Seat Belt
Other Minor
Other Yield
Drunk Driving - Injury
Drunk Driving - no Injury
Suspension
Driving While Suspended/Revoked
Reckless Driving - injury
Reckless Driving - no Injury
Hit and Run - Injury
Hit and Run - no Injury
Speed Contest/Exhibition
Speeding Over 100
Chargeable Accident - no Injury
Chargeable Accident - Injury
Non-Chargeable Accident
month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
year
2004
2005
2006
2007
2008
2009
2010
Add an additional violation?
Yes
No
First name
Last name
Telephone
Email
Zip code
Street address
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