Automobile insurance quotation worksheet
| Driver | Age | Sex | Marital Status | % Use of Vehicle |
|---|---|---|---|---|
| Principal Operator | ||||
| Other Drivers | ||||
| Other Drivers |
| Annual Mileage | |
| Number of days per week or weeks out of 5 weeks if driving in a car pool: | |
| Number of miles one way if driving to and from work every day | |
| Number of accidents of moving violations in the last 3 years List on separate sheet. Use date of conviction for violations. |
| Make | Model | Year | |
|---|---|---|---|
| Auto 1 | |||
| Auto 2 |
| Coverage | Limits or Deductibles | Company 1 Annual Premiums |
Company 2 Annual Premiums |
Company 3 Annual Premiums |
Company 4 Annual Premiums |
|---|---|---|---|---|---|
| Liability (per person) |
$ | $ | |||
| Bodily Injury (per accident) |
$ | $ | |||
| Property Damage (per accident) |
$ | $ | |||
| Uninsured Motorist | |||||
| Libility | $ | $ | |||
| Bodily Injury (per accident) |
$ | $ | |||
| Physical Damage to Insured Vehicle | $ | $ | |||
| Comprehensive Deductible | $ | $ | |||
| Comprehensive (per accident) |
$ | $ | |||
| Collision (per accident) |
$ | $ | |||
| Other Coverages | $ | ||||
| Total Annual Premium | $ | ||||
| Membership Fees (if applicable) | $ | ||||
| Installment Premium Plan | $ | ||||
| Total Cost of Auto Insurance | $ | $ | $ | $ | |
Tips
on lowering premiums
Cancellation or non-renewal of your policy