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Getting a quote is easy.  Just fill out the form below and press the Submit button to submit information to receive a quote on auto insurance. We will be happy to get back to you soon.

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Auto Quote

No coverage is bound until you are contacted by one of our representatives

Name
Street Address
Mailing Address
City, State, Zip
Phone Number Home    Work 
Email    
Do you have insurance on your vehicle(s) now?
If no, when did your last policy expire?
If yes, what company?
If yes, what are your current liability limits?
Current Insurance
a.   Start Date
b.   Expiration Date
Driver Information
1
Name
Social Security Number
Drivers License Number / State
How long licensed?
Date of Birth
Marital Status
List all citation received in past three years. (Including parking, seat belt, defective equipment and other non-moving citations) Include if any driver has had his/her driver's license suspended or revoked, or any major violations during the past 5 years.
List all accidents that were your fault
in past three years.
List all accident that were NOT your fault
in past three years.
2
Name
Social Security Number
Drivers License Number / State
How long licensed?
Date of Birth
Marital Status
List all citation received in past three years. (Including parking, seat belt, defective equipment and other non-moving citations) Include if any driver has had his/her driver's license suspended or revoked, or any major violations during the past 5 years.
List all accidents that were your fault
in past three years.
List all accident that were NOT your fault
in past three years.
3
Name
Social Security Number
Drivers License Number / State
How long licensed?
Date of Birth
Marital Status
List all citation received in past three years. (Including parking, seat belt, defective equipment and other non-moving citations) Include if any driver has had his/her driver's license suspended or revoked, or any major violations during the past 5 years.
List all accidents that were your fault
in past three years.
List all accident that were NOT your fault
in past three years.
4
Name
Social Security Number
Drivers License Number / State
How long licensed?
Date of Birth
Marital Status
List all citation received in past three years. (Including parking, seat belt, defective equipment and other non-moving citations) Include if any driver has had his/her driver's license suspended or revoked, or any major violations during the past 5 years.
List all accidents that were your fault
in past three years.
List all accident that were NOT your fault
in past three years.
Vehicle Information
1
Year     Make     Model
Primary driver
Vehicle ID Number
Body style
How is vehicle primarily used?
If Business, describe type of business
If Commute, how many miles one way?
Select coverage and limits below
 Liability        
 Un(der)insured Motorist   Will Match Liability Selection
 Medical  
 Personal Injury Protection  
 Comprehensive  
 Collision  
 Towing  Company Will Provide Limits
 Rental Reimbursement  Company Will Provide Limits
2
Year     Make     Model
Primary driver
Vehicle ID Number
Body style
How is vehicle primarily used
If Business, describe type of business
If Commute, how many miles one way?
Lien holder
Name
Address
Phone #
Fax #
Loan #
Select coverage and limits below
 Liability      
 Un(der)insured Motorist   Will Match Liability Selection
 Medical/ Personal Injury Protection  
 Comprehensive     
 Collision               
 Towing  Company Will Provide Limits
 Rental Reimbursement  Company Will Provide Limits
3
Year     Make     Model
Primary driver
Vehicle ID Number
Body style
How is vehicle primarily used?
If Business, describe type of business
If Commute, how many miles one way?
Lien holder
Name
Address
Phone #
Fax #
Loan #
Select coverage and limits below
 Liability      
 Un(der)insured Motorist Will Match Liability Selection
 Medical/ Personal Injury Protection
 Comprehensive   
 Collision             
 Towing Company Will Provide Limits
 Rental Reimbursement Company Will Provide Limits
4
Year     Make     Model
Primary driver
Vehicle ID Number
Body style
How is vehicle primarily used?
If Business, describe type of business
If Commute, how many miles one way?
Lien holder
Name
Address
Phone #
Fax #
Loan #
Select coverage and limits below
Liability      
Un(der)insured Motorist Will Match Liability Selection
Medical/ Personal Injury Protection
Comprehensive   
Collision             
Towing Company Will Provide Limits
Rental Reimbursement Company Will Provide Limits
 Please use the space below to add comments regarding any special circumstances or coverage needs

 
 
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Licensed in MA, ME, NH, and NY

info@FandBInsurance.com
85 Exchange Street • Lynn, MA 01901 • Ph. 781.599.2200


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