Automobile Insurance Update

General Information:

Owner's First Name *

Middle

Last *

Address *

City *

State *

Zip *

Date of Birth (mm/dd/yyyy) *

Phone *

Secondary Phone

Email *

Do you currently have life insurance?

Yes
No

If yes, how much?

Do you currently have health insurance?

Yes
No

Do you currently have a home-based business or do you currently own a business?

Yes
No

Answer the following questions to maximize your discounts for auto insurance:

How many years have you lived at your current residence?

How many years have you been with your current insurance company?

Have you taken a certified driver training course and do you have a certificate?

Yes
No

Does your student driver maintain a B average or better? Eligible students will receive a good student discount.

Yes
No

Do you have any children in college and where do they go to school? If eligible, students can receive a student away from home discount.

Do you drive a hybrid vehicle?

Yes
No

Are you a member of one of the following motor clubs?

If AAA Membership, how long have you been a member?

Do you have a Savings Bank Life Insurance or SBLI Life Insurance Policy?

Yes
No

Would you consider paying electronically (EFT) to save 8% on your auto premium?

Yes
No

Are you a member of WBUR/NPR Radio?

Yes
No

Please check the following features that are most important to you: