Get a Quote!

Get a competitive quote from The Insurance Center by filling out this online form. Items with a red asterisk (*) are required. When you are finished, be sure to click the "Submit" button.

NOTE: Unlike many other auto insurance websites you may have come across, we will NEVER sell your information. That means you get fast and accurate quotes without any hassle.

Your Details

* Indicates required field

Name of policyholder-to-be *

First

Last

Gender *

Date of birth (mm/dd/yyyy) *

Marital status *

Daytime phone *

Alternate phone *

Email address *

Postal address *

Line 1

Line 2

City

State

Zip Code

Country

Length of time at this address *

Your Driving Record

How many TICKETS within the last 5 years? *

How many AT-FAULT ACCIDENTS within the last 5 years? *

How many NOT-AT-FAULT ACCIDENTS within the last 5 years? *

How many PIP CLAIMS within the last 5 years? *

Additional Drivers in Your Household

Additional driver #1

Name *

First

Last

Gender *

Date of birth (mm/dd/yyyy) *

Relationship to policyholder *

How many TICKETS within the last 5 years? *

How many AT-FAULT ACCIDENTS within the last 5 years? *

How many NOT-AT-FAULT ACCIDENTS within the last 5 years? *

How many PIP CLAIMS within the last 5 years? *

Additional driver #2

Name *

First

Last

Gender *

Date of birth (mm/dd/yyyy) *

Relationship to policyholder *

How many TICKETS within the last 5 years? *

How many AT-FAULT ACCIDENTS within the last 5 years? *

How many NOT-AT-FAULT ACCIDENTS within the last 5 years? *

How many PIP CLAIMS within the last 5 years? *

Additional driver #3

Name *

First

Last

Gender *

Date of birth (mm/dd/yyyy) *

Relationship to policyholder *

How many TICKETS within the last 5 years? *

How many AT-FAULT ACCIDENTS within the last 5 years? *

How many NOT-AT-FAULT ACCIDENTS within the last 5 years? *

How many PIP CLAIMS within the last 5 years? *

If there are more additional drivers than those listed above, please enter their information in the blank below that asks "Anything else you want to tell us?"

Vehicle Details

Please enter information for every vehicle you want to insure with this policy.

Vehicle #1

Vehicle Identification Number (VIN) (optional) *

YEAR of vehicle *

MAKE of vehicle *

MODEL of vehicle *

Vehicle #2

Vehicle Identification Number (VIN) (optional) *

YEAR of vehicle *

MAKE of vehicle *

MODEL of vehicle *

Vehicle #3

Vehicle Identification Number (VIN) (optional) *

YEAR of vehicle *

MAKE of vehicle *

MODEL of vehicle *

Vehicle #4

Vehicle Identification Number (VIN) (optional) *

YEAR of vehicle *

MAKE of vehicle *

MODEL of vehicle *

If there are more than four vehicles you wish to insure, please provide information for them in the blank below that asks "Anything else you want to tell us?"

Desired Coverage

Bodily Injury Limits *

Property Damage Limits *

Uninsured Motorist (UM) Bodily Limits *

Medical Payments *

Comprehensive *

Collision *

Current Auto Insurance

Do you currently have auto insurance? *

Current auto insurance company *

How long have you been with this company? *

How long have you been insured without any lapse in coverage? *

Expiration or cancelation date of your current policy *

Current policy's Bodily Injury Limit *

Do you own your home? *

Optional Questions

How did you find out about us? *

If "other," please describe *

Anything else you want to tell us? *

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