McGee and Noto Agency | Auto Insurance Quote |

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:

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