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Auto Quote

Contact Information * Required

Todays Date:
(mm/dd/yyyy)
* First Name:
* Last Name:
* Street Address:


* City:
* State:
* Zip:
* County:
* Home Phone: (999-999-9999)
* Work Phone: (999-999-9999)
* Email:
* Are you currently (or have you ever been) a Friends customer?
Yes No
* How did you hear about Friends?
Driver Information * Required
Driver #1
* Name:
* Date of Birth: (mm/dd/yyyy)
* Gender:
* Marital Status:
* Residence:
* Relationship to Driver#1:
Social Security Number: (555-55-5555)
* Drivers License Number:
* At what age did this driver first receive their license?:
* Has this driver been a U.S. or Canadian resident for the past 12 months?:
Yes No
* Has this driver completed Behind-the-Wheel in the last 5 years?:
Yes No
* Is this driver a full-time student with GPA of 3.0 or above?:
Yes No
* In the past 5 years, has the driver's license been suspended or revoked?:
Yes No
* Does the driver require an SR-22 or Financial Responsibility Statement?:
Yes No
* In which state is this driver currently licensed?:
* What is the driver's highest education level?:
* Past or Present Military Experience?:
* What is your occupation?:
* How long have you been with your occupation?:
* In the past 5 years have you filed for bankruptcy?:
Yes No
* In the past 5 years have you had any repossessions, charge offs, or collections?:
Yes No
* How would you describe your credit rating?:
Poor
Good
Excellent
Unsure
Driver #2
Name:
Date of Birth: (mm/dd/yyyy)
Gender:
Marital Status:
Residence:
Relationship to Driver#1:
Social Security Number: (555-55-5555)
Drivers License Number:
At what age did this driver first receive their license?:
Has this driver been a U.S. or Canadian resident for the past 12 months?:
Yes No
Has this driver completed Behind-the-Wheel in the last 5 years?:
Yes No
Is this driver a full-time student with GPA of 3.0 or above?:
Yes No
In the past 5 years, has the driver's license been suspended or revoked?:
Yes No
Does the driver require an SR-22 or Financial Responsibility Statement?:
Yes No
In which state is this driver currently licensed?:
What is the driver's highest education level?:
Past or Present Military Experience?:
What is your occupation?:
How long have you been with your occupation?:
In the past 5 years have you filed for bankruptcy?:
Yes No
In the past 5 years have you had any repossessions, charge offs, or collections?:
Yes No
How would you describe your credit rating?:
Poor
Good
Excellent
Unsure
Driver #3
Name:
Date of Birth: (mm/dd/yyyy)
Gender:
Marital Status:
Residence:
Relationship to Driver#1:
Social Security Number: (555-55-5555)
Drivers License Number:
At what age did this driver first receive their license?:
Has this driver been a U.S. or Canadian resident for the past 12 months?:
Yes No
Has this driver completed Behind-the-Wheel in the last 5 years?:
Yes No
Is this driver a full-time student with GPA of 3.0 or above?:
Yes No
In the past 5 years, has the driver's license been suspended or revoked?:
Yes No
Does the driver require an SR-22 or Financial Responsibility Statement?:
Yes No
In which state is this driver currently licensed?:
What is the driver's highest education level?:
Past or Present Military Experience?:
What is your occupation?:
How long have you been with your occupation?:
In the past 5 years have you filed for bankruptcy?:
Yes No
In the past 5 years have you had any repossessions, charge offs, or collections?:
Yes No
How would you describe your credit rating?:
Poor
Good
Excellent
Unsure
Incident Information
Driver #1

Incident 1:

Date of Incident:
(mm/yyyy)

Incident 2:

Date of Incident:
(mm/yyyy)

Incident 3:

Date of Incident:
(mm/yyyy)

Incident 4:

Date of Incident:
(mm/yyyy)

Driver #2

Incident 1:

Date of Incident:
(mm/yyyy)

Incident 2:

Date of Incident:
(mm/yyyy)

Incident 3:

Date of Incident:
(mm/yyyy)

Incident 4:

Date of Incident:
(mm/yyyy)

Driver #3

Incident 1:

Date of Incident:
(mm/yyyy)

Incident 2:

Date of Incident:
(mm/yyyy)

Incident 3:

Date of Incident:
(mm/yyyy)

Incident 4:

Date of Incident:
(mm/yyyy)

Vehicle Information
Vehicle #1
* Year:
* Make:
* Model:
* VIN #:
* Zip Code where vehicle is garaged most:
* Who is the primary driver of this vehicle?:
* Is the vehicle primarily driven for commuting, business, or pleasure?:
* If used for commuting or business - average number of days per week used?: (enter "0" if not applicable)
* If vehicle is used for commuting - what is the average one-way mileage?:
(enter "0" if not applicable)
*Approximately how many miles is the vehicle driven in a year?: (average american drivers 12,000 per year)
* Current Carrier:
* Current Policy Expiration Date:
(mm/dd/yyyy)
Comprehensive and Collision deductible: Select the amount you are willing to pay in the event of a claim. The higher the deductible the lower the cost for the coverage. Finance companies require you carry this coverage if you are either purchasing or leasing a vehicle.

* Comprehensive:

* Collision:
* Towing Labor:

Yes No

* Rental Reimbursement:

Yes No

* Is this vehicle leased?

Yes No
Vehicle #2
Year:
Make:
Model:
VIN #:
Zip Code where vehicle is garaged most:
Who is the primary driver of this vehicle?:
Is the vehicle primarily driven for commuting, business, or pleasure?:
If used for commuting or business - average number of days per week used?: (enter "0" if not applicable)
If vehicle is used for commuting - what is the average one-way mileage?:
(enter "0" if not applicable)
Approximately how many miles is the vehicle driven in a year?: (average american drivers 12,000 per year)
Current Carrier:
Current Policy Expiration Date:
(mm/dd/yyyy)
Comprehensive and Collision deductible: Select the amount you are willing to pay in the event of a claim. The higher the deductible the lower the cost for the coverage. Finance companies require you carry this coverage if you are either purchasing or leasing a vehicle.

Comprehensive:

Collision:
Towing Labor:
Yes No
Rental Reimbursement:
Yes No
Is this vehicle leased?:
Yes No
       
Vehicle #3
Year:
Make:
Model:
VIN #:
Zip Code where vehicle is garaged most:
Who is the primary driver of this vehicle?:
Is the vehicle primarily driven for commuting, business, or pleasure?:
If used for commuting or business - average number of days per week used?: (enter "0" if not applicable)
If vehicle is used for commuting - what is the average one-way mileage?:
(enter "0" if not applicable)
Approximately how many miles is the vehicle driven in a year?: (average american drivers 12,000 per year)
Current Carrier:
Current Policy Expiration Date:
(mm/dd/yyyy)
Comprehensive and Collision deductible: Select the amount you are willing to pay in the event of a claim. The higher the deductible the lower the cost for the coverage. Finance companies require you carry this coverage if you are either purchasing or leasing a vehicle.

Comprehensive:

Collision:
Towing Labor:
Yes No
Rental Reimbursement:
Yes No
Is this vehicle leased?:
Yes No