Auto Insurance Survey

    Personal Information

    • Automobile Information
    Include all vehichles you wish to insure.

      Car #1 Car #2 Car #3 Car #4 Car #5
    Year
    Make
    Model
    VIN #
    Other Drivers
    Air Bags
    Anti-Lock Brakes
    Driven to work, school, train?
    Miles One Way
    Present Insurance Carrier
    Years With Them
    Current Insurance Expires
    • Liability Limits CSL Vehicle(s) Collision Deductible Comprehensive Deductible
    250/500/100 500 1 100 250 500 NC 100 250 500 NC
    100/300/100 300 2 100 250 500 NC 100 250 500 NC
    50/100/50 500 3 100 250 500 NC 100 250 500 NC
    25/50/50 500 4 100 250 500 NC 100 250 500 NC


    • REQUIRED AUTO INSURANCE DOCUMENTS

    1. Copy of NJ drivers licenses - all drivers in the residence (showing proper/current residence address)
    2. Proof of residency - may be one of the following and cannot be over 30 days old:
      1. current utility bill- electric, phone, gas, etc.
      2. checking account statement
      3. credit card bill
      4. household lease
      These items need to show current the name and address.
    3. Valid current vehicle registration with current address showing.
    4. Evidence of current or prior insurance coverage.
      1. copy of valid policy
      2. proof of insurance for 6 years
      3. cancellation notice with cancel date or non-renewal notice from State Farm
    5. List of ALL licensed operators in the household and proof that they are insured elsewhere. (ID card)
    6. Use of vehicle; mileage driven to work or school.
    7. Drivers license record and tickets or accidents. (Statement of driving record).
    8. If new purchase - copy of odometer statement, window sticker & temporary Registration.
    * If your current policy is due to expire or renew shortly it is imperative that you have all the necessary documents 1 ready and your application is completed far in advance to make certain there is no lapse in coverage.

Services We Offer