| Select
Policy Type * |
NJ PAIP Rates are set by the State Dept of Insurance. You wont
have to shop around. |
| How Many
Points DMV or Insurance Points do you have?
* |
NJ-MVC/NJ-DMV and or Insurance points added together. |
| Have you
been declined coverage? |
Have any companies declined you coverage. |
| Is Your
License SUSPENDED? |
If Suspended You will need A Licensed Driver. |
| Any
AT-Fault Accidents last 36 months * |
At Fault accidents are 5 insurance points each. |
| Phone #'s
to reach you? * |
(111) 111-1111 Multiple numbers are OK. |
| |
|
| Email
Address/s? * |
Email where quote will be sent. |
| Email
Address Again * |
Verify Email address to send quote to |
| Last Name?
* |
|
| First
Name? * |
|
| Vehicle #1
Year|Make|Model * |
2005 Ford Mustang LS give as much information as
possible. 4x4, se, dl, le etc. For most accurate quotes include Vehicle ID
Number (VIN) |
| Vehicle
#2 Year|Make|Model |
Leave blank if no other vehicles |
| Your
County? * |
Enter your NJ County of Residence |
| Town
Name/City? * |
Enter your NJ City of Residence |
| Male or
Female? * |
NJ PAIP Rates are gender based |
| Date Of
Birth/Age * |
Example: 01/01/1964 |
| Marital
Status * |
|
| Distance
Driven- miles per day * |
One Way mileage to work or school. |
| Liability
Limits needed * |
Financed & Leased usually require $100/300 |
| Property
Damage needed * |
Financed & Leased usually require $50,000 |
| PIP
Personal Injury Protection needed * |
This covers medical expenses from auto accident etc. |
| PIP
Personal Injury Protection deductible * |
Your out of pocket deductible |
| Airbags?
* |
|
| Physical
Damage Comprehensive * |
Full Coverage Comprehensive Deductible |
| Collision
Coverage * |
Full Coverage Collision Deductible |
| Street
Address? * |
|
| Zip?
* |
|
| Your
State? * |
Quotes for New Jersey Residents Only. |
| Are cars
Leased/Financed/Paid Off? * |
Leased Cars usually require 100/300/50,000. |
| Is vehicle
Registered to you? * |
|
| How many
licensed drivers in house: TOTAL # * |
Please select the total number of licensed drivers in your
household. |
| When do
you Need Coverage? |
|
| Have you
Had a DUI/DWI last 5 years? |
DUI-DWI is 9 Insurance Points |
| Additional
Information Other Drivers-Other Vehicles |
Please list other drivers that need to be covered here Age M/F
points vehicle driven etc. |
| Your Quote
will be emailed. |
You may need to check bulk Email folder to find
your quote |