Tell your date of birth

An effective date is the date upon which something is considered to take effect. This is the date that coverage should start.

Please tell us the year, Make, & Model of the vehicle you would like to add to your policy.

What is a VIN? ---------------
The car's vehicle identification number (VIN) is the identifying code for a SPECIFIC automobile. It is just like the car's fingerprint. A VIN is composed of 17 digits and characters that act as a unique identifier for the vehicle. A VIN displays the car's unique features, specifications and manufacturer. The VIN can be used to track recalls, registrations, warranty claims, thefts and insurance coverage. Where can I find the VIN?
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The VIN can be found by looking at the dashboard on the driver side of the vehicle. If the VIN cannot be found, open the driver side door and look at the door post (where the door latches when it is closed). It is likely that the VIN will also be displayed in this location.

Please list all safety features that your car has.

IF this vehicle is New and you are the first owner, please tell us what your vehicle cost.

An odometer is an instrument that indicates distance traveled by a vehicle, such as an automobile. It is sometimes called a mileometer or milometer.

How many miles will this vehicle be driven in a year?

The primary driver of a vehicle is the person who drives that particular vehicle the most.

Comprehensive Deductible: This optional coverage pays for sudden and accidental damage to your car that is caused by something other than a collision. • This includes damage caused by such things as fire, theft, hail, vandalism, riots, damage caused by animals, and glass breakage. • Not every non-collision related loss is covered under Comprehensive Coverage. For instance, damage is not covered if it is caused by wear and tear, freezing, or mechanical breakdown. Also, damage to or theft of certain personal property within your car, such as tapes and compact disks, is not covered under your auto policy. • Any customization you do to your vehicle after it is purchased is not covered unless you notify your insurance company. • There are various deductible options that you can select for this coverage. The maximum amount paid under Comprehensive Coverage is the actual cash value of your auto (what your auto is worth today) minus the deductible, unless this coverage is modified by a separate endorsement.

Collision Deductible: This optional coverage pays for sudden and accidental damage from collision or rollover to your auto no matter who causes the accident. Collision Coverage applies if your auto is struck by another vehicle or if your auto hit another object that caused damage to your auto. There are various deductible options that you can select for this coverage. The maximum amount that would be paid under Collision Coverage is the actual cash value of your auto (what your auto is worth today) minus the deductible, unless this coverage is modified by a separate endorsement.

Rental Car Reimbursement. What's Covered? Pays to rent a car if you have a loss covered under Comprehensive or Collision coverage. How much does it pay? Pays up to the limit selected per day to the maximum indicated. Your coverage limits, deductibles and certain exclusions may apply. Please see your policy for details.

Roadside assistance is a service that provides a support service to stranded vehicles that have suffered from a particular breakdown while driving or traveling. These breakdowns include but are not limited to the following •Mechanical failure •Dead or drained battery •Keys lost or locked within the vehicle •Vehicle has run out of gas •Flat tire Pays up to the limit selected per disablement. Your coverage limits, and certain exclusions may apply. Please see your policy for details.

Gap Coverage Protects "Upside Down" Car Buyers To see just how you could end up in that situation, consider this scenario, in which your car has taken a trip downriver during a record-breaking flood just one year after you drove it home from the lot: •Amount you owe on your auto loan $20,000 •Your car's book value at the time of loss 15,000 •Your insurance deductible 500 •Amount the insurance company pays you 14,500 •The gap $5,500 Gap protection is intended to cover the difference between the value of your car at the time it's totaled and your outstanding loan balance.

Custom Parts and Equipment/Accessory Coverage or CPE. CPE covers permanently attached equipment, devices, accessories, enhancements and changes, other than those that the manufacturer originally installs, that alter the appearance or performance of an automobile. This includes, but is not limited to: •Special roofs and deluxe roof treatment •All custom paint work and deluxe exterior •Chrome and reverse chrome •Alloy or magnesium wheels/wheel covers, aluminum wheels or wire-spoke wheels •Special tires •Chrome engine accessories •Racing slicks, oversize tires or custom wide-tread tires •Camper tops, T-Bar roof and T-tops including glass •TV, VCR or DVD players that are permanently installed in the vehicle •Anti-theft equipment not installed by the auto manufacturer •Aftermarket racing seats or leather seats not installed by the auto manufacturer •Alcohol detection systems that are not permanently installed Examples of unacceptable custom equipment: •TVs, radios and CD players and similar electronic devices that are not permanently installed in the vehicle •Radar detectors •Tapes, CDs and containers used to store them •CB radios, telephones or two-way mobile radios that are not permanently installed in the vehicle •Alcohol detection systems that are not permanently installed Special manufacturer trim packages, such as special editions, sport packages or packages featuring specific designers or outdoor outfitters are not considered additional equipment. Please note: We recommended you take photos of the custom parts and equipment installed in or on your vehicle and save all your receipts. Example: Your car has a custom paint job, aluminum wheels and special tires that total $5,000. You purchase an additional $5,000 in CPE coverage to ensure the parts are covered if they're damaged in an accident.

Please tell us the year, Make, & Model of the vehicle you would like to REMOVE from your policy.

If you have 2 or more vehicle of the same year, make, and model please include the last 4 digits of the VIN of the vehilce that you would like to remove, So that we remove the the correct one.

Storage insurance coverage basics The first thing you want to think about is the type of auto insurance coverage that you will need on a car that you do not drive. The logical conclusion you may arrive at is that you will not require collision insurance if your vehicle is in storage (and thus not being driven). The type of coverage that you would need would be the kind given by a comprehensive storage insurance policy. This is the type of policy that aims to cover eventualities other than collisions, which can damage your car just as much as – if not more than – the typical collision. When your car is in storage, you do not need to protect yourself from the costs associated with collisions, but you still need protection from everything else. Request a free quote for storage auto insurance today! What exactly is covered with storage auto insurance? Most comprehensive auto insurance policies of this sort cover any number of potential calamities. Some of the most common protections that these policies provide will cover theft and vandalism, as well as damages sustained due to fire, flood, and animal damages. The limits of a policy are decided by your insurance company, but these examples give you a general idea. Storage insurance helps to protect your car from damage, even when it is locked away. The fact is, an estimated 77% of drivers choose to purchase comprehensive auto insurance; storage insurance, as a form of comprehensive coverage can help protect your most treasured vehicle – whether it's a collector's car, or even that auto that you're storing away until your child's 16th birthday.

Good Student Discount: Young drivers may qualify for a discount for having good grades (A/B average)or 3.0. Driver Training Discount: Young drivers (under age 21) who complete a driver-training course may qualify for this discount. Student Away at School Discount: Policyholders with a dependent (under age 25) who goes away to school (100 plus miles away) may qualify for this discount.

Please attach Proof of drivers training, and proof of grades. Or you may fax them to 800-517-4759

Please include any and all tickets, claims or accidents that this driver has had in the last 5 years. OR you may use this box to tell us anything you would like to add.