Auto Quote — San Diego General Insurance
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Contact
Request Evidence of Insurance
Make Changes To Your Policy
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San Diego General Insurance
Info
Contact
Request Evidence of Insurance
Make Changes To Your Policy
Get a Quote
Automobile Quote Questionnaire
Name
*
First Name
Last Name
Email Address
*
Phone
*
(###)
###
####
Mailing Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Vehicles
Year of Vehicle One
*
Make of Vehicle One
*
Toyota, Honda, etc.
Model of Vehicle One
*
Camry, F-150, etc.
VIN of Vehicle One
17 digit vehicle identification code
Current odometer reading
Must be accurate not rounded up
Year of Vehicle Two
Make of Vehicle Two
Model of Vehicle Two
VIN of Vehicle Two
Current odometer reading
Must be accurate not rounded up
Year of Vehicle Three
Make of Vehicle Three
Model of Vehicle Three
VIN of Vehicle Three
Current odometer reading
Must be accurate not rounded up
Year of Vehicle Four
Model of Vehicle Four
VIN of Vehicle Four
Current odometer reading
Must be accurate not rounded up
If you own more than 4 cars: List the year, make, model and VIN of any other cars you own here. Label them as "Vehicle Five" and so on.
Drivers
Name of Driver One
*
First Name
Last Name
Birthdate
*
Occupation of Driver One
If student, is GPA 3.0 or better?
Yes
No
Age Driver One was Licensed
Which vehicle does this driver operate?
Vehicle One
Vehicle Two
Vehicle Three
Vehicle Four
Vehicle Five
Other
If other, please provide which vehicle the driver operates.
What vehicle usage does Driver One use?
*
Drive to work/school
Pleasure use (around town only)
Business use (real estate agent, etc)
Ride Share use (Uber, Lyft, etc.)
Other
If other, please provide the usage.
Has Driver One had any tickets in the last 5 years?
Yes
No
If yes, please provide the following: Date, type of ticket (speeding, violation, etc.)
Has Driver One had any accidents in the last 5 years?
Yes
No
If yes, please provide the following: Date, Amount Paid, Description of accident, and who was at fault.
Name of Driver Two
First Name
Last Name
Birthdate
Occupation of Driver Two
If Student, is GPA 3.0 or better?
Yes
No
Age Driver Two was Licensed
Which vehicle does Driver Two operate?
Vehicle One
Vehicle Two
Vehicle Three
Vehicle Four
Vehicle Five
Other
If other, please provide which vehicle the driver operates.
What vehicle usage does Driver Two use?
Drive to work/school
Pleasure use (around town only)
Business use (real estate agent, etc)
Ride Share use (Uber, Lyft, etc.)
Other
If other, please provide the vehicle usage.
Has Driver Two had any tickets in the last 5 years?
Yes
No
Unsure
If yes, please provide the following: Date, type of ticket (speeding, violation, etc.)
Has Driver Two had any accidents in the last five years?
Yes
No
If yes, please provide the following: Date, Amount Paid, Description of accident, and who was at fault.
Name of Driver Three
First Name
Last Name
Birthdate
Occupation of Driver Three
If Student, is GPA 3.0 or better?
Yes
No
Age Driver Three was Licensed
Which vehicle does Driver Three operate?
Vehicle One
Vehicle Two
Vehicle Three
Vehicle Four
Vehicle Five
Other
If other, please provide which vehicle the driver operates.
What vehicle usage does Driver Three use?
Drive to work/school
Pleasure use (around town only)
Business use (real estate agent, etc)
Ride Share use (Uber, Lyft, etc.)
Other
If other, please provide the vehicle usage.
Has Driver Three had any tickets in the last 5 years?
Yes
No
Unsure
If yes, please provide the following: Date, type of ticket (speeding, violation, etc.)
Has Driver Three had any accidents in the last five years?
Yes
No
If yes, please provide the following: Date, Amount Paid, Description of accident, and who was at fault.
Name of Driver Four
First Name
Last Name
Birthdate
Occupation of Driver Four
If student, is GPA 3.0 or better?
Yes
No
Age Driver Four was Licensed
Which vehicle does this driver operate?
Vehicle One
Vehicle Two
Vehicle Three
Vehicle Four
Vehicle Five
Other
If other, please provide which vehicle the driver operates.
If other, please provide the usage.
What vehicle usage does Driver Four use?
Drive to work/school
Pleasure use (around town only)
Business use (real estate agent, etc)
Ride Share use (Uber, Lyft, etc.)
Other
Has Driver Four had any tickets in the last 5 years?
Yes
No
If yes, please provide the following: Date, type of ticket (speeding, violation, etc.)
Has Driver Four had any accidents in the last 5 years?
Yes
No
If yes, please provide the following: Date, Amount Paid, Description of accident, and who was at fault.
Please list any other drivers here and identify them as "Driver Five" and so on. Include name, birthdate, occupation, if student B or Better GPA? vehicle usage, and identify any tickets or accidents they have on their record.
Section 5
Requested Bodily Injury Limit
15/30
25/50
30/60
50/100
100/300
250/500
500/500
Requested Property Damage Limit
5
10
25
50
100
250
500
Requested Uninsured Motorist Limit
15/30
25/50
30/60
50/100
100/300
250/500
500/500
Requested Medical Payments Limit
none
1000
2000
5000
10,000
25,000
100,000
Comprehensive Deductible
none
50
100
250
500
1000
1500
2500
Requested Collision Deductible
none
50
100
250
500
1000
1500
2500
If you do NOT want comprehensive coverage on all vehicles, please provide which vehicles do not need this coverage.
If you do NOT want collision coverage on all vehicles, please provide which vehicles do not need this coverage.
Check any other coverages you want on your policy.
Towing
Rental Car
GAP
Questions/Comments
Current Insurance Company
Renewal date
Are you a member of Costco?
Yes
No
Are you a member of AAA roadside assistance?
Yes
No
Thank you!