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Home > Automobile > Parents of Teens Auto Quote
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Parents of Teen Drivers


Thank you for giving 12 Times Better Insurance an opportunity to earn your business. This is the most detailed quote template that can answer multiple carriers questions. If your unsure of a particular question, or if it does not apply, just go on to the next section.   

Better Insurance Niches in Time, by 12 Times. 


Gender *
First Name *
Last Name *
Street *
City *
State *
ZIP / Postal Code *
Primary Phone Number *
E-Mail Address *
Current Insurance Provider
Current Policy End Date
/ /
Length of Coverage (Months and Years)
If your insurance is not active, when did it cancel?
Do you know your Liability Limits are on your current or previous insurance?
Do you Own or Rent your home?
AAA MEMBER?
Driver 1-Date of birth
Gender
Marital status
#1-USA Year/Month first licensed or age
Driver's license number and State.
Highest Level of Education
#1-Moving or non-moving violations past 5 years-list approximate month/year
#1-Accidents at-fault or non-fault past 5 years-list approximate month
Name of Driver 2
Driver 2 -DOB
Gender *
Marital status
Relationship *
Driver's license number and State.
#2-USA Year/Month first licensed or age
#2-Moving or non-moving violations past 5 years-list approximate month
#2-Accidents at-fault or non-fault past 5 years-list approximate month
Name of Driver 3
Driver 3-DOB
Driver's license number and State.
#3-USA Month/Year first licensed or age.
Driver's license number & State
#3-Moving or non-moving violations past 5 years-list approximate month
#3-Accidents at-fault or non-fault past 5 years-list approximate month
#3 - If Student, please list Grade Point Average
Liability Limit
Uninsured Motorist Bodily Injury
Uninsured Motorist Property Damage
Do you want Personal Injury Protection?(PIP)
Vehicle 1 year, make, model *
Vehicle 1 VIN
Vehicle 1 - Comprehensive Deductible
Vehicle 1 - Collision Deductible
Vehicle 1- Rental
Vehicle 1 - Towing
Vehicle 1 - Average Commute in Miles
Vehicle 1 - How many days per week do you commute?
Annual Miles Vehicle 1
#1 Month/Year purchased vehicle?
Are you towing anything? *
Vehicle 2 year, make, model
Vehicle 2 VIN
Vehicle 2 - Comprehensive Deductible
Vehicle 2 - Collision Deductible
Vehicle 2- Rental
Vehicle 2 - Towing
Commute miles one-way and days per week
Annual Miles Vehicle 2
#2 Month/Year purchased vehicle?
Commute miles one-way and days per week
Month/Year purchased vehicle
Vehicle 3 year, make, model
Vehicle 3 - Comprehensive Deductible
Vehicle 3 - Collision Deductible
Vehicle 3- Rental
Vehicle 3 - Towing
Vehicle 3 VIN
Would you consider a Auto Homeowners package for the best prices?
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