Auto Insurance Quote
For California residents only.
Click the SUBMIT button to receive your free quote. Remember should you wish to speak to a live person you can always phone us at 888-MY-INS-GUY/888-694-6748 (M-F 8:00 - 5:00).
Customer Information
Name
E-mail
Street address
City
County
State
Zip Code
Home Phone
Work Phone
FAX
Vehicle Information
Vehicle
Year
Make
Model
Body Type (Select all that apply)
1
2Dr
4Dr
Pickup
Van
Wagon
4WD
2
2Dr
4Dr
Pickup
Van
Wagon
4WD
3
2Dr
4Dr
Pickup
Van
Wagon
4WD
Additional Vehicle Information
Vehicle
Vehicle ID #
(if known)
Miles Driven
to Work
Cost New
Safety
Features
1
-- select --
Recreation
Under 3 Miles
3-10 Miles
10-20 Miles
Over 20 Miles
Business
Air bags
Anti-Lock Brakes
Automatic Seat Belts
2
-- select --
Recreation
Under 3 Miles
3-10 Miles
10-20 Miles
Over 20 Miles
Business
Air bags
Anti-Lock Brakes
Automatic Seat Belts
3
-- select --
Recreation
Under 3 Miles
3-10 Miles
10-20 Miles
Over 20 Miles
Business
Air bags
Anti-Lock Brakes
Automatic Seat Belts
Requested Auto Insurance Coverages
Vehicle
Liability
Limits
Uninsured
Motorist
Medical
Collision Deductible:
Comprehensive Deductible:
1
-- select --
15/30/25
25/50/25
50/100/50
100/300/100
250/500/250
300csl
-- select --
None
15/30
30/60
25/50
50/100
100/300
250/500
-- select --
None
$1,000
$2,000
$5,000
$10,000
$25,000
$50,000
$100,000
-- select --
None
$100
$250
$500
$1000
-- select --
None
$100
$250
$500
$1000
2
-- select --
None
$100
$250
$500
$1000
-- select --
None
$100
$250
$500
$1000
3
-- select --
None
$100
$250
$500
$1000
-- select --
None
$100
$250
$500
$1000
Drivers Information
DR#
Drivers Name
Date of Birth
Marital
Status
# Yrs Lic'd
Sex
Drivers
License #
State
Lic'd
Past 1 year...
Past 3 years...
# Acc
# Viol
# Acc
# Viol
1
Select one
Single
Married
M
F
2
Select one
Single
Married
M
F
3
Select one
Single
Married
M
F
More Driving History for ALL Drivers & Comments
Insurance Information
Current Insurance
Expiration Date
Reporting Method
How would you like to receive
your free Auto Insurance quote?
U.S.Postal
E-mail
Fax
Home Page
|
E-Mail
Gary Jones Insurance Agency
CA License #0E22842
insure@iinsureit.com
508 Main Street
310-615-0940 Phone
888-MY-INS-GUY
El Segundo, CA 90245
310-615-0994 Fax
888-694-6748
