Independent Insurance Agency
Hyannis Office: (508) 775-6060    Dennis Office:(508) 398-6060
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Auto Insurance Quote

We provide auto insurance coverage in Massachusetts only. We are on Cape Cod and local to Barnstable in Hyannis, and also in Dennis.

Please complete this form and submit it. Someone from our office will get back to you within 2 business days.
If you need help please call us at 508-775-6060 or send an email.


1. Full Name

2. Address

3. City

4. State

5. Zip

6. Address Where Car is Parked (if different)

7. City
 8. State
 9. Zip

10. Email

11. Cell Phone

12. Home Phone

13. Work Phone / Ext.:

14. Fax

15. Best Time To Contact

You can scroll to the bottom of the page and submit your request for a quote now and have someone from our office contact you to help you, or fill out the remainder of the form here to give us more information.

16. Currently Insured? Yes No

16a. Are you a AAA member?? Yes No

17. Expiration Date of Current Policy (optional) (MM/DD/YY)

18. Any Student operator from Age 16 ½ - 25 on the honor roll (B or 3.0 or better average)? Yes No

19. Do you have a Massachusetts Homeowners policy?  If yes, name of company as many companies offer discounts? Yes No

Driver Information

20. How many drivers are in the household?

1 2 3 4
21. Last Name
22. First Name
23. Middle Initial
24. Date of Birth (mm/dd/yy)
25. License Number
26. State Issued
27. Drivers Education or Advanced Driving training class within the last 60 days? Yes No Yes No Yes No Yes No
28. How long have you been licensed to drive?
29. Any moving violations, DUI's or at-fault accidents in the past 6 years? Yes No Yes No Yes No Yes No
30. Is the driver listed as a driver on any other Massachusetts Auto policy? Yes No Yes No Yes No Yes No

Vehicle Information

31. Number of vehicles to be quoted

1 2 3 4
32. Year (i.e. 1995)
33. Make
34. Model
35. Sub Model
36. Body Style
37. Is this a Hybrid vehicle? Yes No Yes No Yes No Yes No
38. VIN#
39. Air Bags Yes No Yes No Yes No Yes No
40. Automatic Seat Belts Yes No Yes No Yes No Yes No
41. Anti-Theft
42. Vehicle Usage
43. If for business, describe how vehicle(s) are used in business
44. Town vehicle is principally garaged in
45. Annual Miles Driven (approximately)
46. Un-insured Motorist Coverage (choose one) (Part 3 of your existing policy)
47. Property Damage to Someone Else's Property (choose one) (part 4 of your existing policy)
48. Optional Bodily Injury Increased Limits (part 5 of your existing policy) (choose one)
49. Medical Payments (part 6 of your existing policy) (choose one)
50. Collision Deductible (part 7 of your existing policy) (choose one)
51. Comprehensive (fire/theft/vandalism/glass coverage) Deductible (part 9 of your existing policy) (choose one)
52. Substitute Transportation (Car Rental) coverage per day (part 10 of your existing policy) Yes No Yes No Yes No Yes No
52a. If Yes to #52, (choose one)
53. Towing (part 11 of your existing policy) Yes No Yes No Yes No Yes No
53a. If Yes to #53, (choose one)
54. Underinsured Motorist (part 12 of your existing policy)

55. Questions and/or Comments

Requests for quotes handled during regular business hours are processed within 48 hours - often much sooner if possible.
Information is only used to provide you with quotes.

Important Note: Quotes will be based on the information provided. It is only a rate calculation and is not binding in any way. A full application must be completed and signed by the named insured.

Your Cape Cod Independent Insurance Agency for barnstable auto insurance, barnstable  home insurance, barnstable business insurance, barnstable  commercial insurance, auto insurance cape cod, home insurance cape cod, business insurance cape cod, commercial insurance cape cod, hyannis auto insurance, hyannis  home insurance, hyannis business insurance, hyannis  commercial insurance.

Help?

When filling out this form, leave blank any fields for which you do not know the answer. Be sure that you give us either an email address or a phone number so that we can call you back. If you haven't heard from us within one business day please call and follow up with us.

Insurance Coverage Available - Local to Cape Cod, Barnstable, Hyannis, South Dennis

  • Homeowners Insurance
  • Renters Insurance
  • Automobile Insurance
  • Flood Insurance
  • Commercial Insurance
  • Workers Comp Insurance
  • Liability Insurance
  • Health Insurance Insurance
  • Life Insurance Insurance
  • Dental Insurance
  • Long Term Care Insurance
  • Annuities Insurance
  • Disability Insurance
  • Umbrella Insurance
  • Bonds
  • Boat Insurance
  • Wedding Insurance
  • Event Insurance