Personal and Commercial insurance to our friends and neighbors
for over 40 years

McGee and Noto Agency - 1819 E. Ridge Road - Rochester, NY 14622 - 585-342-4920


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Auto Insurance Quote

YOUR PERSONAL DATA    
Name:  
Property Address:  
City:  
State: (Must Be NY)  
Zip Code:  
E-Mail (REQUIRED):    
E-Mail again for accuracy:    
Phone:  
Fax (optional):  
Marital Status:   Homeowner?
Single Married   Yes No
Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)
 

DRIVER INFORMATION #1
Name:   Birthdate:
Gender: Male Female   # Years U.S. Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:

Number & Type of Accidents last 3 years:

 

Number & Type of MINOR Cites last 3 years:

Number & Type of MAJOR Cites last 3 years:

  Daily commute in ONE WAY miles:

DRIVER INFORMATION #2 (If None Leave Blank)
Name:   Birthdate:
Gender: Male Female   # Years U.S. Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:

Number & Type of Accidents last 3 years:

 

Number & Type of MINOR Cites last 3 years:

Number & Type of MAJOR Cites last 3 years:

 

Daily commute in ONE WAY miles:

If More than 2 Drivers, list Additional Driver's Names, Birthdates, and driving record history here:  

VEHICLE #1 INFORMATION
(if "Non-Owners", type "NON-OWNER" in "YEAR" Field)

Year of Vehicle

 

Make and Model

Vehicle ID# (for rating accuracy)  

Annual Mileage:

 

Used in business?
(Explain, if yes):

Select Liability Limits  
Select Comprehensive Deductible:  
Select Collision Deductible:  
Uninsured Motorists Coverage?   Yes No
Rental Car & Towing Coverage?   Yes No
Medical and/or PIP Coverage:  

VEHICLE #2 INFORMATION (if none, leave blank)

Year of Vehicle

 

Make and Model

Vehicle ID# (for rating accuracy)  

Annual Mileage:

 

Used in business?
(Explain, if yes):

Select Liability Limits   Liability Limits Must Match Vehicle #1
Select Comprehensive Deductible:  
Select Collision Deductible:  
Uninsured Motorists Coverage?   Yes No
Rental Car & Towing Coverage?   Yes No
Medical and/or PIP Coverage:  
Comments or Remarks
(List Additional Drivers, Autos, etc., here)
 
If More than 2 Vehicles or Drivers, list Additional Vehicles Year, Makes, and Models, and Driver's Ages and Driving records here:  
Send my quotation via:   E-Mail Fax Regular Mail
Call Me By Phone


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