Free Automobile Insurance Quote - Ira G. Mohler & Son, Inc.

Driver's Name*

DOB*
(Mo/Da/Yr)

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Number

Auto Insurance Quote

Please take a few moments to supply the requested information in order to receive a free insurance quote. When you finish, click the "Submit" button at the bottom of the page and the information will automatically be sent to us. You will see a confirmation page that indicates our receipt of the information. We will respond shortly with a competitive insurance quote. If you have questions about any terms, see the bottom of the page for an explanation. Fields that must be filled out are marked with an asterisk (*); all others are optional.

Automobile Insurance Information

Name:*
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Driver Information

Violations & Claims in Last 3 Years

	Type	Description	Driver No.	Date (Mo/Da/Yr)	Amount Paid/Points
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Vehicle Information

	Year*	Make*	Model*	Doors*
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	VIN#	Security Alarm	Air Bag	4WD*
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	Automatic Seatbelts	ABS Brakes	Annual Miles*
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4

	Commuting Miles to Work* (1 way)	Deductible Comprehensive*	Deductible Collision*
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Requested Coverages

	First Party Benefits Medical Payments*	Bodily Injury*	Property Damage*	Uninsured & Underinsured Motorist Bodily Injury*	Limited Tort
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Other Information

Definitions

4WD - four-wheel drive

ABS - Antilock Braking System brakes

Vehicle Make - The manufacturing company of the vehicle such as Ford, Chrysler, Acura, etc.

Vehicle Model - The name of the specific kind of vehicle given by the manufacturer such as Taurus, LeBaron, Integra, etc.

VIN# - "Vehicle Information Number", this unique number can be found on the inside panel of your driver's side door

Deductible Comprehensive - Covers glass breakage, fire, theft, etc.

Deductible Collision - Covers vehicle damage due to a collision.

First Party Benefits or Medical Payments - This pays medical bills for the policy holder and others covered by the policy regardless of fault.

Bodily Injury - If the policyholder injures someone in a car accident, this coverage pays their medical and rehabilitation expenses and any damages for which the insured is found liable for causing.

Property Damage - If someone's property is damaged in an accident for which the insured is at fault, this coverage pays for it.

Underinsured Motorist Bodily Injury - This pays for losses if the policy holder is hit by a motorist who does not have enough insurance to pay policyholder's claim.

Uninsured Motorist Bodily Injury - This pays for losses if policyholder is hit by a motorist who has no insurance to pay policyholder's claim.

Limited Tort - Offers savings on premiums. All out-of-pocket medical and other expenses can be recovered but non-monetary damages are not able to be recovered. Also, payments are not made for pain and suffering unless injuries are defined as serious.

Full Tort - Rights are retained to bring suit against the negligent party.