Auto Insurance Questions Step 1 of 7 14% Name Email Number Address of where you currently liveDo you own or rent this property? Own Rent Have you lived here for more than 3 years? Yes No Previous Address Are You Married? Yes No Does your spouse have a driver license? Yes No Non-Driver/Unlicensed SpouseFull NameDate Birth Do you currently have car insurance? Yes No Who do you have car insurance with now? How many years have you been with this car insurance company? Less than 1 year 1 Year 2 Years 3 Years or more How much are you paying monthly? When does it expire?MMDDYYYY Please provide everyone in the household with a driver license or a learner's permit (Including yourself, spouse, children, parents, etc..)Full NameDate BirthRelationship To YouDriver License #Issued State# of Accidents in the last 5 years# of moving violationsDate of Defensive Driving Course Completion Please provide information on the cars you have in your householdVIN# of CarUsing Car For?Who Drives it? Have you or any driver(s) had more than one accident per driver in the last 3 years? Yes No Have you or any driver(s) had their license suspended because of a moving violation? Yes No Have you or any driver(s) been convicted of a DUI or DWI? Yes No Have you or any driver(s) had a speeding violation 85 mph or more in last 3 years?* Yes No How much do you currently pay for car insurance? When do you need the insurance to start?MMDDYYYY If you are purchasing a new condo/co-op, please use your closing date or estimate closing date.Any special concerns or questions? Please ask here.
