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Auto   Commercial Auto   Motorcycle   Life Insurance   Homeowners   Condominium   Renters   Business   Boat   Flood       It's Simple... Answer the following questions and click the "Inquire Now" button. Your information will be immediately and securely sent to Tinelli Agency. (866) 809-1400 *Required Information *Your quote will be based on the minimum coverage required, unless you otherwise specify. 1.About You First Name* Last Name* Email* Street Address* City* Zip Code* Phone (Day)* Phone (Evening)* Fax DOB (mm/dd/yyyy)* Your Driver License Number Occupation* 2.About your vehicle and additional questions Do you currently have auto insurance? * Yes No If you answered 'yes' to having auto insurance: When does your current policy expire? (mmddyyyy) Who are you currently insured with? Has your insurance recently lapsed? Yes No Length of Time With a Previous Carrier? less than 1 year 1+ year 5+ years Coverage Desired? Liability Full Coverage Not Sure Bodily Injury Limits Desired? 20,000 to 40,000 25,000 to 50,000 50,000 to 100,000 100,000 to 300,000 250,000 to 500,000 100,000 Single Limit 300,000 Single Limit 500,000 Single Limit Not Sure Any moving violations, tickets or accidents in the past 3 years?* No tickets or accidents 1 ticket or accident 2 tickets or accidents 3 tickets or accidents 4 tickets or accidents 5 tickets or accidents Please detail the moving violations/tickets/accidents: Does the vehicle have an alarm?* No Active Passive Alarm Only Lojack What is the primary use?* Pleasure Work What is your Marital Status?* Married Single Widowed Divorced Separated Rate your own credit * Excellent Above average Average Poor 2 or 4 Wheel Drive?* not sure 2 wheel drive 4 wheel drive How Many Cylinders?* Not Sure 4 cylinders 6 cylinders 8 cylinders Vehicle Make * Vehicle Model * Year Built * VIN # How many miles a year do you drive?* less than 7.500 more than 7'500 Do you own a home or rent?* Own a Home Rent Are you a * Male Female 3.Additional Drivers? Include in quote? Yes No Number of Drivers Additional Driver's Name Birth Date Month 01 02 03 04 05 06 07 08 09 10 11 12 Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Any Accidents? No Not At Fault Accident At Fault Accident Any Moving Violations? Never 1 2 3 4 5 or more Additional Driver's Name Birth Date Month 01 02 03 04 05 06 07 08 09 10 11 12 Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Any Accidents? No Not At Fault Accident At Fault Accident Any Moving Violations? Never 1 2 3 4 5 or more Additional Driver's Name Birth Date Month 01 02 03 04 05 06 07 08 09 10 11 12 Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Any Accidents? No Not At Fault Accident At Fault Accident Any Moving Violations? Never 1 2 3 4 5 or more 4.Additional Vehicles? Include in quote? Yes No Vehicle Make Vehicle Model Year Built VIN # How many miles a year do you drive? less than 7.500 more than 7'500 Does the vehicle have an alarm? No Active Passive Alarm Only Lojack What is the primary use? Pleasure Commute Business (Corporate) Business (Individual) Government Competition    We will call you with the lowest quote possible on information you provided.
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