Added car quote questionnaire

Quote for adding or replacing a vehicle

The best way for us to help get you an accurate estimate for a potential new vehicle is to complete this 3-4 minute questionnaire as best you can. The more detail you can provide, the more accurate the estimate will be. If you have actually purchased a vehicle, or are for sure purchasing a vehicle soon and you need to actually send us information for a change, please use this form instead: https://hipaa.jotform.com/230186711182148
When are you thinking about getting this vehicle?*
Would this vehicle replace a vehicle on the policy?*
What is the Year Make & Model of the vehicle you will trade in
What is the Year Make & Model of the vehicle you are considering*
Enter the VIN # for most accurate quote
A VIN number helps us make this a REALLY accurate estimate
Anyone besides you and/or your spouse on the title?*
Who will typically drive this vehicle*
ONE WAY distance to work or school of the person who will typically drive this vehicle *
Best guess on mileage is completely fine
Anyone besides you, your spouse, or other household members going to drive this vehicle?*
Will this vehicle be used for, delivery of any people or products, or any uber/lyft or other ridesharing?*
Would you like to add accident forgiveness to keep your rate from increasing after a claim?
Generally cost is about 2-3% of your current rate. Answering this wont make the change - this just lets us know if you'd like us to talk about it or not
It is important to get OEM parts if your vehicles is damaged or be paid 10% above the repair value?
Name*

First NameLast Name
What is your best phone number?*
Please enter a valid phone number.
What is your best email address?*
example@example.com
Any questions or anything else important that you think we should know about this?
Please verify that you are human*
I understand and have read the full disclosure below*
Remember, no coverages can be bound, changed, or cancelled until you get confirmation from a licensed agent of the McGinniss Himmel Insurance Agency, LLC. This form allows us to more accuratly and quickly help get you taken care of but submission of this form does not confirm or change your coverage. We OFTEN can respond to these within 2-4 hours, but please allow us 24 hours to review and contact you with options and confirmation of coverage.

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Quote for adding or replacing a vehicle