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Specializing in convenience industry.  Among the largest insurers of gas and convenience stores in lower NY (NYC, Rockland, Westchester, Putnam, Dutchess & Orange Counties.)

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Auto Insurance Quote

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Contact Form
* First Name:
* Last Name:
* Address:
* City:
* State/Zip:
,
Work Phone:
(+ area code) Ext.
* Home Phone:
(+ area code)
Fax:
(+ area code)
E-mail:
Driver Information
Driver #1
* First Name:
* Last Name:
* Gender:
Male
Female
* Marital Status:
Single
Married
Divorced
Widowed
Separated
* Years Licensed:
* State Licensed:
* Driver's License Number:
Occupation:
* Date of Birth:
(mm/dd/yyyy)
Driver #2
First Name:
Last Name:
Gender:
Male
Female
Marital Status:
Single
Married
Divorced
Widowed
Separated
Years Licensed:
State Licensed:
Driver's License Number:
Occupation:
Date of Birth:
(mm/dd/yyyy)
Driver #3
First Name:
Last Name:
Gender:
Male
Female
Marital Status:
Single
Married
Divorced
Widowed
Separated
Years Licensed:
State Licensed:
Driver's License Number:
Occupation:
Date of Birth:
(mm/dd/yyyy)
Vehicle Information
Vehicle #1
* Year:
* Make:
* Model:
* VIN:
Miles per Year:
Vehicle use:
Work
Pleasure
Miles one way:
Vehicle #2
Year:
Make:
Model:
VIN:
Miles per Year:
Vehicle use:
Work
Pleasure
Miles one way:
Vehicle #3
Year:
Make:
Model:
VIN:
Miles per Year:
Vehicle use:
Work
Pleasure
Miles one way:
Coverage Information
Bodily Injury:
Property Damage:
Current Insurance with:
Expiration Date:
(mm/dd/yyyy)
Deductable Information Vehicle #1
Comp. Theft:
Collision:
Rental Reiumbursement:
Yes No
Towing:
Yes No
Full Glass
Yes No
Deductable Information Vehicle #2
Comp. Theft:
Collision:
Rental Reiumbursement:
Yes No
Towing:
Yes No
Full Glass
Yes No
Deductable Information Vehicle #3
Comp. Theft:
Collision:
Rental Reiumbursement:
Yes No
Towing:
Yes No
Full Glass
Yes No
Comments
Validation Code:
* Validation Code:

Please Note: Insurance coverage cannot be bound without a written binder from our office.

Additionally, Please Note: Many insurance carriers use information gathered from you and outside sources about your claim, driving and credit history. This information allows insurance companies to determine accurately the proper price to charge. You are entitled to a free copy of the reports by contacting the appropriate consumer reporting agency within the next 60 days.

By filling out this quote you agree to the above terms.