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We sell Auto insurance,Antique insurance for individual and family households...ANTIQUE AUTO INSURANCE...
Classic Auto Insurance

InsuranceCompany.com is a specialist in antique auto insurance and classic auto insurance coverage programs. The antique - classic auto insurance program provides coverage for the small to medium size vehicle used mainly for exhibitions, club activities, parades and other functions of public interest. This vehicle is not a regular car used for household errands, vacations or going to work. All vehicles must be kept in a locked garage and not left unattended when in use. It is for personal use not related to daily activities or a business and registered to you or a household family member.

This program provides liability insurance coverage, uninsured motorists, underinsured motorists, PIP, medical, comprehensive, collision and more...  Coverage is available according to your state law and insurance code regulations.

If the auto is a business use vehicle please select the business auto option. If the vehicle is for regular use please select the personal auto option. If the vehicle is a large size vehicle (2 1/2 ton or more) and used regularly in a business please select the commercial vehicle option.

ANTIQUE  AUTO  WORKSHEET
First Name:
Last Name:
Garaging Address:
Garaging City:
Garaging State:
Garaging Zip Code:
Phone Number:
Fax Number:
E-Mail Address:
 
MAILING  ADDRESS
(optional)
Mailing Address
If Different from Garaging:
Mailing City:
Mailing State:
Mailing Zip Code:
 
DRIVER  INFORMATION
  Driver One Driver Two Driver Three Driver Four
First Name
Birthdate
Sex
Marital Status
Yrs Licensed
State Licensed
Occupation
 
VEHICLE  INFORMATION
  Vehicle 1 Vehicle 2 Vehicle 3
Year
Make
Model
I.D. #
Value $
Vehicle Status
Is This Vehicle Secured in a Locked garage?
Miles Driven
Each Year
Ownership
 
VIOLATION  INFORMATION
Last 3 Yrs (Minors)
Last 5 Yrs (Majors)		 Driver 1 Driver 2 Driver 3 Driver 4
Minor Violations - Speeding,
Turn, Stop Sign, Red Light, etc.
Accidents - Non Chargeable
Accidents - Chargeable
Major Violations - Drunk Driving,
Reckless, Hit & Run, etc.
 
COVERAGE  INFORMATION
  Bodily Injury Property Damage
Personal Liability
Uninsured Motorist
Medical Payment:  
 
DEDUCTIBLE  INFORMATION
  Vehicle 1 Vehicle 2 Vehicle 3
Comp (Theft)
Collision
 
MISC.  INFORMATION
Current Insurance Company:
Expiration Date:
Current Premium $:
Questions or Comments
to help the Agent:
Please press the Submit Button ONLY ONE TIME
Wait a few moments for an online acknowledgement

Thank you for choosing InsuranceCompany.com
 we look forward to serving you and your family...
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