Request Multi-Vehicle Proposal
Please answer the questions the best you can so we can game plan your next insurance. We represent many carriers and so there is a multitude of questions to cover most carriers. These questions are there to help you get a better rate. Please use Additional Information at the bottom to provide more vehicles, drivers, or any other information. We always try to respond promptly the same day or on the next business day. Thank you for giving 12 Times Better Insurance Plus an opportunity to earn your business.
How did you hear about us?
Personal Information
Date of Birth *
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Marital Status *
Relationship *
Current Renewal Date
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Approximate time & name of any major, minor or non-moving violations last 5 years
List at-fault, non-fault & Comprehensive claims last 5 years
Spouse Information
Date of Birth *
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If yes, List name and approximate time for any major, minor, non-moving violations last 5 years
List any at-fault, non-fault accidents or Comprehensive claims last 5 years
Date of Birth *
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Marital Status *
Relationship *
Approximate time & name of any major, minor or non-moving violations last 5 years
List at-fault, non-fault & Comprehensive claims last 5 years
Date of Birth
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Marital Status *
Relationship *
Approximate time & name of any major, minor or non-moving violations last 5 years
List any at-fault, non-fault accidents or Comprehensive claims last 5 year
Date of Birth *
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Marital Status *
Relationship *
List any at-fault, non-fault accidents or Comprehensive claims last 5 year
Approximate time & name of any major, minor or non-moving violations last 5 years
Date of Birth
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List at-fault, non-fault & Comprehensive claims last 5 years
Collision Deductible
Comprehensive Deductible
Collision Deductible
Comprehensive Deductible
Comprehensive Deductible
Collision Deductible
Collision Deductible
Comprehensive Deductible
Collision Deductible
Comprehensive Deductible
Additional Information
Important NoticeAny
submissions or payments made via this website do not constitute a
binding agreement to your policy or coverages. Changes and
payments to policies are not effective or binding until you, or any
party involved, receive official notice from either your insurance agent,
or your insurance company. If you have any questions, please feel free to
contact us. Per the terms of our
online privacy policy we will not resell your information to any third-party.
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