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(916) 334-5773 phone
5805 Watt Avenue
North Highlands, CA 95660
(916) 334-5661 fax

 


Get an Auto Insurance Quote

Welcome to Big Dan's "Get An Auto Insurance Quote" page. Just fill in the blanks below and when you're done, click on the Submit button. Your quote will be in your e-mail box within 24 business hours.

We will use this information for quoting and contacting purposes only. We do not sell information to third parties.

TELL US ABOUT YOURSELF
I am a :
First Name:
Middle Initial:
Last Name:
Street Address :
City:
State:
Zip Code:
Home Phone:
Work Phone:
Other Phone:
Email Address:
How Many Months Have You Maintained Un-interrupted Auto Insurance:
Housing: Own   Rent   Live with Parents
If You Own, Which Insurance Co. and Expiration Date:
Own A Major Credit Card:

Yes No

DRIVER #1 INFO
Driver #1 Name

Years Licensed in CA
Years Licensed in US
Date of Birth (MM/DD/YY):

Gender: Male Female
Marital Status:
# of Miles One Way to Work or School:

Number of Moving Violations For Last 3 Years:

Were You "At Fault" For An Accident Last 3 Years: Yes No
If Yes,Were There Bodily Injuries: Yes No
Number of Accidents Last 3 Years:
(Include Details Below)
Number of DUI's Last 3 Years:
Need An SR-22: Yes No


DETAILS SECTION

For Additional Accidents:
Indicate Chargeable or Non-chargeable
Injury or Non-injury

For Suspensions:
Indicate Dates From and To

DRIVER #2 INFO
Driver #2 Name

Years Licensed in CA
Years Licensed in US
Date of Birth (MM/DD/YY):

Gender: Male Female
Marital Status:
# of Miles One Way to Work or School:

Number of Moving Violations For Last 3 Years:

Were You "At Fault" For An Accident Last 3 Years: Yes No
If Yes,Were There Bodily Injuries: Yes No
Number of Accidents Last 3 Years:
(Include Details Below)
Number of DUI's Last 3 Years:
Need An SR-22: Yes No


DETAILS SECTION

For Additional Accidents:
Indicate Chargeable or Non-chargeable
Injury or Non-injury

For Suspensions:
Indicate Dates From and To

 
DRIVER #3 INFO
Driver #3 Name

Years Licensed in CA
Years Licensed in US
Date of Birth (MM/DD/YY):

Gender: Male Female
Marital Status:
# of Miles One Way to Work or School:

Number of Moving Violations For Last 3 Years:

Were You "At Fault" For An Accident Last 3 Years: Yes No
If Yes,Were There Bodily Injuries: Yes No
Number of Accidents Last 3 Years:
(Include Details Below)
Number of DUI's Last 3 Years:
Need An SR-22: Yes No


DETAILS SECTION

For Additional Accidents:
Indicate Chargeable or Non-chargeable
Injury or Non-injury

For Suspensions:
Indicate Dates From and To

VEHICLE #1 INFO
Year:
Make:
Model:
VIN (optional):
Vehicle Used Mostly For: Pleasure   Work  
Deliveries   Business

 

If Vehicle Is Used For Work or Business, Please Describe:

VEHICLE #2 INFO
Year:
Make:
Model:
VIN (optional):
Vehicle Used Mostly For: Pleasure   Work  
Deliveries   Business

 

If Vehicle Is Used For Work or Business, Please Describe:

VEHICLE #3 INFO
Year:
Make:
Model:
VIN (optional):
Vehicle Used Mostly For: Pleasure   Work  
Deliveries   Business

 

If Vehicle Is Used For Work or Business, Please Describe:

WHAT COVERAGE DO YOU NEED
Bodily Injury:
Property Damage:
Uninsured Motorist:
Uninsured Motorist Property Damage: Yes   No
Medical Payments:
Comprehensive/Collision Deductibles:
On Which Vehicle(s) for Comp/Collision: Veh 1  Veh 2 
Both
Towing: Yes   No
Rental Reimbursements: Yes   No
SUBMIT INFORMATION
(You only need to press Submit once)



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