Auto Insurance Quote Information:
General Information
Primary Applicant Name:
Date of Birth:
Address/Garaging:
City & Zipcode: , KY
Phone:
Email:
Retype Email:
Co-Applicant Name:
Do you Rent or Own? Rent Own
All Drivers' Names & Date of Births for each:
Vehicle Information:
VIN Number:
Make, Model and Year of Vehicle:
Primary Use: Personal Business
Does it have any Anti-Theft Devices? Yes No
Any Violations? Yes No

Any violations such as speeding tickets, accidents or dui’s for any drivers listed?  If so, what was the date of occurance? (Very important to list this as it will change amount of your quote).

List Violations with Dates:
Coverage: (Questions that your Strong Insurance Agent will ask when they call)

What type of coverage do you currently have full coverage or liability only?

What limits do you want for bodily injury and property damage?

Collision and Comprehensive 500 deductible or 1000 deductible?

What limits do you want for Uninsured and Underinsured Motorist?

Who is your current insurance carrier? How long have you been insured with them? When does policy expire?

Do you want coverage for towing and rental car?