Auto Insurance Quote Via E-mail

We can send you a quote via e-mail if you complete the form below.

If you would rather just have us call you for a quote, click here.

Note: Due to individual state licensing restrictions, we are only able to provide quotes for residents of California.

Your Information: The name fields, the e-mail field and the zip code field are required. The zip code must be the zip code where the vehicles are garaged (where you live). We will not send unsolicited e-mail (spam) to you, nor will we release your e-mail address to anyone else.

First Name (Required)
Last Name (Required)
E-mail Address (Required)
Street Address
Unit or Apartment #
City or Town
State	CA
Zip Code (Required)
Home Phone
Work Phone	x

Vehicle Information: Describe your vehicles as completely as possible. If you don't know the submodel, leave that field blank. If your vehicle has no after-market equipment, leave the customization field blank.

Vehicle #	Year	Make	Model	Submodel EX/DX/GT etc.	$ Amount Customization? (CD,rims,etc.)	# Miles Driven Per Year
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Vehicle 5

Driver Information: All fields must be completed for each driver.

	First Name	Last Name	Date of Birth	# of Years Licensed in U.S.	Need SR-22 filing?	Sex?	Married?	Occupation	# years continuous insurance	How many miles to work/school	Drives vehicle #
Driver 1					No Yes	Female Male	No Yes
Driver 2					No Yes	Female Male	No Yes
Driver 3					No Yes	Female Male	No Yes
Driver 4					No Yes	Female Male	No Yes
Driver 5					No Yes	Female Male	No Yes
Driver 6					No Yes	Female Male	No Yes

Ticket/Accident/Claim Information: List all tickets, accidents and auto insurance claims from the past 7 years. List ALL accidents, even if they weren't your fault. If you went to traffic school and had a ticket dismissed, indicate "dismissed" in the description section. If you have no tickets, accidents or claims in the past 7 years, check this box:

Ticket/Accident/Claim	Date	Injuries?	Driver #	Description
Ticket Accident -- My Fault Accident -- Not My Fault Claim		No Yes	1 2 3 4 5 6 None Other
Ticket Accident -- My Fault Accident -- Not My Fault Claim		No Yes	1 2 3 4 5 6 None Other
Ticket Accident -- My Fault Accident -- Not My Fault Claim		No Yes	1 2 3 4 5 6 None Other
Ticket Accident -- My Fault Accident -- Not My Fault Claim		No Yes	1 2 3 4 5 6 None Other
Ticket Accident -- My Fault Accident -- Not My Fault Claim		No Yes	1 2 3 4 5 6 None Other
Ticket Accident -- My Fault Accident -- Not My Fault Claim		No Yes	1 2 3 4 5 6 None Other
Ticket Accident -- My Fault Accident -- Not My Fault Claim		No Yes	1 2 3 4 5 6 None Other
Ticket Accident -- My Fault Accident -- Not My Fault Claim		No Yes	1 2 3 4 5 6 None Other
Ticket Accident -- My Fault Accident -- Not My Fault Claim		No Yes	1 2 3 4 5 6 None Other

Bodily Injury:

Select a limit of coverage $15,000/$30,000 $25,000/$50,000 $30,000/$60,000 $50,000/$100,000 $100,000/$300,000 $250,000/$500,000 $1,000,000/$1,000,000

Bodily Injury Liability Coverage: This is the coverage which pays for the other person's injury related damages that you would be required to pay should you be found legally liable in an accident. Any damages or judgment in excess of the limits that you choose will be YOUR RESPONSIBILITY to pay. In order to satisfy a judgment, you may be forced to sell assets such as your home. In addition, the party securing a judgment against you could garnish your wages to satisfy that judgment. Higher limits can be purchased with little increase in the premium. All cars will have the same limit.

Property Damage:

Select a limit of coverage $5,000 $10,000 $25,000 $50,000 $100,000

Property Damage Liability Coverage: This is the coverage which pays for damages to another person's property (their car, house, sign post, etc.) that you would be required to pay should you be found legally liable in an accident. Any damages or judgment in excess of the limits that you choose will be YOUR RESPONSIBILITY to pay. In order to satisfy a judgment, you may be forced to sell assets such as your home. In addition, the party securing a judgment against you could garnish your wages to satisfy that judgment. Higher limits can be purchased with little increase in the premium. All cars will have the same limit.

Medical Payments:

Select a limit of coverage 1,000 $2,000 $5,000

Medical Payments Coverage: This coverage pays for medical expenses incurred by you and anyone in your vehicle as the result of an accident. This coverage can either pay for medical expenses not covered by your regular medical insurance (excess) OR it can pay for medical expenses regardless of whether or not you have other health insurance (primary). The cost for primary Medical Payments Coverage is twice that of excess Medical Payments Coverage. If anyone without medical coverage drives or rides in your car, or if you wish additional medical expense coverage for injuries resulting from an accident, you should buy this coverage. Medical expense coverage can be added or increased for not much additional premium.

I want medical payments to be:

Excess Primary I do not want it at all.

Uninsured Motorist Bodily Injury:

Select a limit of coverage $15,000/$30,000 $25,000/$50,000 $30,000/$60,000 $50,000/$100,000 $100,000/$300,000 $250,000/$500,000 $1,000,000/$1,000,000

Uninsured Motorist Coverage: This is a very valuable coverage available at a very low premium. This coverage pays for medical expenses, lost earnings and general damages for the occupants of your vehicle should you be involved in an accident caused by an uninsured motorist. It can also pay up to $3,500 to repair or replace your vehicle if the accident is caused by an uninsured motorist. Like liability coverage, the bodily injury part of this coverage is available in different limits. Purchasing higher limits can be done for a very small increase in premium. This coverage is so very inexpensive that we strongly recommend that every policy include this coverage at the highest limit available. However, the limits for Uninsured Motorist Coverage cannot exceed the limits that you choose for Liability Coverage.

Vehicle #	Collision Deductible
Vehicle 1	No Coverage $0 Deductible $50 Deductible $100 Deductible $200 Deductible $250 Deductible $500 Deductible $1,000 Deductible
Vehicle 2	No Coverage $0 Deductible $50 Deductible $100 Deductible $200 Deductible $250 Deductible $500 Deductible $1,000 Deductible
Vehicle 3	No Coverage $0 Deductible $50 Deductible $100 Deductible $200 Deductible $250 Deductible $500 Deductible $1,000 Deductible
Vehicle 4	No Coverage $0 Deductible $50 Deductible $100 Deductible $200 Deductible $250 Deductible $500 Deductible $1,000 Deductible
Vehicle 5	No Coverage $0 Deductible $50 Deductible $100 Deductible $200 Deductible $250 Deductible $500 Deductible $1,000 Deductible

Collision Coverage: This coverage pays for damage to your car resulting from collision with another motor vehicle, rolling the car or running into an inanimate object such as a tree. It pays regardless of who causes the accident. This coverage comes with a deductible which is the amount that you pay towards a loss before the company pays. The smaller your deductible, the less you have to pay when you have a loss. Smaller deductibles do result in a higher premium while larger deductibles result in a lower premium. We recommend that you select deductibles as high as you could comfortably afford in the event of a loss.

Vehicle #	Comprehensive Deductible
Vehicle 1	No Coverage $0 Deductible $50 Deductible $100 Deductible $200 Deductible $250 Deductible $500 Deductible $1,000 Deductible
Vehicle 2	No Coverage $0 Deductible $50 Deductible $100 Deductible $200 Deductible $250 Deductible $500 Deductible $1,000 Deductible
Vehicle 3	No Coverage $0 Deductible $50 Deductible $100 Deductible $200 Deductible $250 Deductible $500 Deductible $1,000 Deductible
Vehicle 4	No Coverage $0 Deductible $50 Deductible $100 Deductible $200 Deductible $250 Deductible $500 Deductible $1,000 Deductible
Vehicle 5	No Coverage $0 Deductible $50 Deductible $100 Deductible $200 Deductible $250 Deductible $500 Deductible $1,000 Deductible

Comprehensive Coverage: This coverage pays for damage to your car caused by reasons other than collision. A couple of examples would be theft or vandalism. It does not cover mechanical failure. This coverage comes with a deductible which is the amount that you pay towards a loss before the company pays. The smaller your deductible, the less you have to pay when you have a loss. Smaller deductibles do result in a higher premium while larger deductibles result in a lower premium. We recommend that you select deductibles as high as you could comfortably afford in the event of a loss.

Rental Car Reimbursement:

Select a limit of coverage $20 per day/30 days max $30 per day/30 days max $40 per day/30 days max $50 per day/30 days max

Rental Reimbursement Coverage: This coverage pays for you to rent a vehicle while your vehicle is disabled as a result of a covered loss under either Comprehensive or Collision coverages. This coverage is not offered by all companies and you must purchase Comprehensive Coverage in order to add it to your policy. This coverage can pay $20, $30, $40 or $50 per day towards the rental car, depending on which limit you purchase. This coverage is so very inexpensive (as low as $14 per vehicle every 6 months) that we strongly recommend that every eligible policy include this coverage at the highest limit available.

Towing:

Select a limit of coverage $35 max per disablement $70 max per disablement

Towing Coverage: This coverage pays for towing your vehicle or for minimal roadside work done on the vehicle should it become disabled on the roadway. This coverage is not offered by all companies and you must purchase Comprehensive Coverage in order to add it to your policy. This coverage can pay either $35 per disablement or $70 per disablement towards the necessary tow or emergency roadside assistance. This coverage is designed to get your vehicle going again or to remove it to the nearest location where it can be fixed. This coverage is so very inexpensive (as low as $3.00 per vehicle every 6 months) that we strongly recommend that every eligible policy include this coverage at the highest limit available.

Whew!!! That's it! Now all we need you to do is to indicate below how you would like us to contact you and then hit the submit button.

Please contact me via:

Phone E-mail Mail