Massachusetts Auto Quote
We provide insurance coverage in Massachusetts only.
Sorry, other states not available.

Hyannis Insurance Office
88 Falmouth Rd. * Hyannis, MA 02601
Tel. 508.775.6060 * Fax 508.790.1414

South Dennis Insurance Office
485 Rte. 134 * PO Box 1497 * S. Dennis, MA 02660
Tel. 508.398.6060 * Fax 508.394.2267

In a hurry? Simply fax us a copy of your existing Auto policy coverage page to 508.790.1414. We can give you a quote from that!

1. Full Name

2. Mailing Address
3. City
 4. State
 5. Zip

6. Address Where Car is Parked (if different)
7. City
 8. State
 9. Zip

10. Name of Current Automobile Insurance Company

11. Email

12. Home Phone

13. Work Phone / Ext.:

14. Fax

15. Best Time To Contact

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

Home Page
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.