Auto Insurance Review

Contact Info

1. Your Name(required)
2. Email(valid email required)
3. Home Phone
4. Cell Phone
5. Work Phone
6. Street Address
7. City
8. ZIP

Account Info

1. I have a young driver recently licensed or who will be licensed in the next year.
2. Yes No
3. I have licensed drivers in my household not listed on my auto policy.
4. Yes No
5. Are there non-residents in your household who frequently use your vehicle?
6. Yes No
7. I have vehicles in my household (other than a company vehicle) that are not insured on my policy with The Brouwers Agency.
8. Yes No
9. I have a company vehicle furnished for my regular use.
10. Yes No
11. I am completely satisfied with my current liability limits.
12. Yes No
13. I would definitely consider raising my deductibles to save money on my policy. Please quote.
14. Yes No
15. WARNING--Non-factory installed equipment (e.g. rims, stereo, tv/dvd player) is not automatically covered without adding coverage. Do you have these items?
16. Yes No
17. My vehicle(s) is used in business, sales, or deliveries.
18. Yes No
19. I want rental reimbursement coverage. If not already covered, in the event my car is damaged in an accident. Please call me to add rental car reimbursement.
20. Yes No
21. I have the following items that are NOT currently insured on my policy: Motorcycle, Moped, ATV, Dirt Bike, Motor Home, Golf Cart, Snowmobile, Camper, Antique Auto, Trailer
22. Yes No
23. I want to make sure that I am SAVING all the money I can on ALL my insurance. I own or rent a home, apartment, or condo not insured with The Brouwers Agency. Please quote.
24. Yes No
25. I want towing coverage in the event my car is disabled for any reason.
26. Yes No
27. I have a vehicle or vehicles NOT registered in my or my spouse’s name.
28. Yes No
29. My car is now titled in a trust.
30. Yes No
31. Please send me an ID card for each of my vehicles.
32. Yes No

 

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