Auto Insurance Quote - Monteleone Insurance

Auto Insurance Quote – Monteleone Insurance

In efforts to find you the best value and coverage From ALL our carriers, kindly fill out the following questions to the best of your ability.

If you do not know the answer, please leave blank or reach out to our team for guidance.

Thank you!

Questions or Requests: BRoeder@MonteleoneAssociates.com or 631-544-4000.

Name

Phone Number

Email *

Parking Address

Current Policy Info

Upload Your Current Policy (For Comparison Of Coverages)

Click or drag files to this area to upload. You can upload up to 3 files.

How Long Have You Been With Current Carrier (Months/Years)?

What Are Your Current Bodily Injury Liability Limits (EX: $100,000/$300,000)? - Skip If You Uploaded Your Current Policy

What Is Your Current Property Damange Liability Limit (EX: $100,000)? - Skip If You Uploaded Your Current Policy

What Is Your Current Annual Premium? If Policy Is For 6 Month Terms Please Confrim. - Skip If You Uploaded Your Current Policy

If Second Policy Exists Please Upload Here or Fill Out This Form Using A Separate Link

Click or drag files to this area to upload. You can upload up to 3 files.

Driver's Information

Driver #1 Name, Date Of Birth & License #

Upload Driver #1 Driver's License

Click or drag files to this area to upload. You can upload up to 3 files.

Does Driver #1 Have A Defensive Drivers Course (if yes confirm date of completion)?

Upload Driver #1 Defensive Drivers Certificate - Only If Applicable

Click or drag files to this area to upload. You can upload up to 3 files.

Driver #2 Name, Date Of Birth & License #

Upload Driver #2 Driver's License - Only If Applicable

Click or drag files to this area to upload. You can upload up to 3 files.

Does Driver #2 Have A Defensive Drivers Course (if yes confirm date of completion)?

Upload Driver #2 Defensive Drivers Certificate - Only If Applicable

Click or drag files to this area to upload. You can upload up to 3 files.

Driver #3 Name, Date Of Birth & License #

Upload Driver #3 Driver's License

Click or drag files to this area to upload. You can upload up to 3 files.

Does Driver #3 Have A Defensive Drivers Course (if yes confirm date of completion)?

Upload Driver #3 Defensive Drivers Certificate - Only If Applicable

Click or drag files to this area to upload. You can upload up to 3 files.

Are Any Of The Drivers Married? If Yes, Which Drivers?

Do Any Of The Drivers Own A Home? If Yes, Which Drivers?

Are There Other Licensed Drivers In The Household Not Listed Above?

Vehicle Information

Confirm Vehicle #1 Make/Model/Year - Skip If You Uploaded Your Current Policy

Confirm Vehicle #1 Identification Number (VIN) - Skip If You Uploaded Your Current Policy

Is Vehicle #1 Owned or Leased?

Vehicle #1 Purchase or Lease Date

Is Vehicle #1 Financed? If Yes, Who Is The Lienholder?

Confirm Vehicle #2 Make/Model/Year (IF APPLICABLE) - Skip If You Uploaded Your Current Policy

Confirm Vehicle #2 Identification Number (VIN) - Skip If You Uploaded Your Current Policy

Is Vehicle #2 Owned or Leased?

Vehicle #2 Purchase or Lease Date

Is Vehicle #2 Financed? If Yes, Who Is The Lienholder?

Confirm Vehicle #3 Make/Model/Year (IF APPLICABLE) - Skip If You Uploaded Your Current Policy

Confirm Vehicle #3 Identification Number (VIN) - Skip If You Uploaded Your Current Policy

Is Vehicle #3 Owned or Leased?

Vehicle #3 Purchase or Lease Date

Is Vehicle #3 Financed? If Yes, Who Is The Lienholder?

Claim Info

Do you and/or your spouse have any driving, claims tickets or accidents within the past 5 years? If yes, please confirm basic details. Kindly note we will run Motor Vehicle Reports as well. (Please note a standard Motor Vehicle Report will be processed).

43963