I need help with *
NJPAIP-NJ Car Insurance Quote
I need advice Not Sure
NJ-PAIP Rates are set by the State Dept of Insurance. You wont have to shop around. Please select desired policy type.
How Many Points DMV/Insurance Points added together? *
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
more than 30
MVC/DMV and or Insurance points added together.
Have you been declined coverage?
NA
YES
NO
Have any companies declined you coverage.
Is Your License SUSPENDED?
NO
YES
Getting Restored
If Suspended You will need A Licensed Driver on your policy.
Any AT-Fault Accidents last 36 months *
NO
1
2
3
4
5
6
7
8
9
10
Select number of AT-FAULT accidents.
Phone #'s to reach you? *
(111) 111-1111 Multiple numbers are OK. Indicate day number please.
Best Contact Method
Email Address/s? *
Email Address Again *
Last Name? *
First Name? *
Vehicle #1 Year|Make|Model| *
2005 Ford Mustang LS give as much information as possible. 4x4, se, dl, le etc.
Vehicle #2 Year|Make|Model|
Leave blank if no other vehicles
Your County? *
Atlantic County
Bergen County
Burlington County
Camden County
Cape May County
Cumberland County
Essex County
Gloucester County
Hudson County
Hunterdon County
Mercer County
Middlesex County
Monmouth County
Morris County
Ocean County
Passaic County
Salem County
Somerset County
Sussex County
Union County
Warren County
Select your NJ County of Residence
Town Name/City? *
Male or Female? *
Male
Female
NJ-PAIP Rates are gender based
Date Of Birth *
Marital Status *
Single
Married
Divorced
Widow/er
Distance Driven- miles per day *
1
2
3
4
5
6
7
8
9
10
More than 10
One Way mileage to work or school.
Liability Limits needed *
15/30,000
25/50,000
50/100,000
100/300,000
250/500,000
0-NO Liability-BASIC ONLY
10,000 BASIC POLCY ONLY
Financed & Leased usually require $100/300
Property Damage needed *
$5,000
$10,000
$25,000
$50,000
$100,000
5,000 BASIC POLICY ONLY
Financed & Leased usually require $50,000
PIP Personal Injury Protection needed *
$250,000
$150,000
$75,000
$50,000
$15,000
15,000 BASIC POLICY ONLY
This covers medical expenses from auto accident etc.
PIP Personal Injury Protection deductible *
$250
$500
$1000
$2,000
$2,500
Your out of pocket deductible
Would you like multiple quotes?
NO
YES
Multiple company quotes could save you money?
Airbags? *
No Airbags
Yes 1 Airbag
Yes 2 or more Airbags
Physical Damage Comprehensive *
NO Liability Only
Yes $500 deductible
Yes $750 deductible
Yes $1000 deductible
Yes $1500 deductible
Yes $2,000 deductible
Full Coverage Comprehensive Deductible
Collision Coverage *
NO Liability Only
Yes $500 deductible
Yes $750 deductible
Yes $1000 deductible
Yes $1500 deductible
Yes $2,000 deductible
Full Coverage Collision Deductible
Street Address? *
Zip? *
Your State? *
NJ
Quotes for New Jersey Residents Only.
Are cars Leased/Financed/Paid Off? *
Financed
Leased
Paid Off
Leased/Financed usually require 100/300/50,000 If leased you will need a copy of the lease.
Is vehicle Registered to you? *
Yes Registered to me
No Registerd to someone else
Registered to Lease Company
Title is OK, Registration Expired Ok,
How many licensed drivers in house: TOTAL # *
1
2
3
4
5
6
7
8
9
10
Please select the total number of licensed drivers in your household.
When do you Need Coverage?
ASAP
This Week
Next Week
This Month
Next Month
Later
Have you Had a DUI/DWI last 5 years?
No
Yes
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.
