DAGGETT
AUTOMOBILE  INSURANCE

 

    

    

    

    

    

    

   

   

   


#1 Best Price on Automobile Insurance!

To get a quote on automobile insurance please call 315-253-9900 or use the form below.

Name:

Address:
Address (line 2 if needed):
City:
State:
(Our agency can only sell insurance in the state of New York)
Phone Number:
E-Mail Address:
Date of Birth
Drivers License Number:
Social Security Number
Do you own, or rent your home? I Rent my home
I own my home
Do you have a current, active insurance policy for the last 6 months? Yes     No
If yes, with who?
Number of years licensed:

Please list any traffic violations, accidents, or suspensions in the last 5 years?
Have you taken any Defensive Driving Courses? Yes      No
If yes, enter date taken:
Have you taken Drivers Education?   Yes      No
Do you have a College Degree? Yes, I have an Associates Degree 
Yes, I have a Bachelors Degree (or better)
No, I do not have a College Degree 
What year is your Automobile?
What make is your automobile?
What is the model of your Automobile
Select the coverage options from the list below. If you would like to get a quote for more than one option select each option you are interested in.
Limits of liability requested: (State Required Minimum)
      $25,000 Per Person
      $50,000 Per Accident
      $10,000 Property Damage

$50,000 Per Person 
      $100,000 Per Accident
      $50,000 Property Damage

$100,000 Per Person 
      $300,000 Per Accident
      $50,000 Property Damage
Physical Damage -  Comprehensive Deductible Requested:  $200 deductible with full glass coverage 
$250 deductible with full glass coverage
$250 deductible with full glass coverage
Physical Damage - Collision Deductible Requested: $200 collision deductible
$250 collision deductible
$500 collision deductible
Are you employed? Yes      No
If yes, how many miles is it to work each day?
How many drivers are there in your Household?

Please enter information below fore each of the licensed operators in the household.
Driver 1:              Name:
Date of Birth
Social Security Number
Drivers License Number:
Driver 2:              Name:
Date of Birth
Social Security Number
Drivers License Number:
Driver 3:              Name:
Date of Birth
Social Security Number
Drivers License Number:
Driver 4:              Name:
Date of Birth
Social Security Number
Drivers License Number: