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Quotes Insurance Quotation System
Welcome!!!
108 Theodore Specht Dr.
P.O. Box 513
Fredericksburg, TX 78624
Tel: 830-997-9531
Fax: 830-997-4691
wendy@frantzen-insurance.com
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Life Insurance
Supplemental Health
Next Day Coverage
Discount Benefits
Home Insurance
Auto Insurance
Request For Auto Insurance Quote
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more info..
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Personal Details
First Name
*
Last Name
*
Contact Details
Street
City
State
*
Select State
ALASKA
ALABAMA
ARKANSAS
ARIZONA
CALIFORNIA
COLORADO
CONNECTICUT
DISTRICT OF COLUMBIA
DELAWARE
FLORIDA
GEORGIA
HAWAII
IOWA
IDAHO
ILLINOIS
INDIANA
KANSAS
KENTUCKY
LOUISIANA
MASSACHUSETTS
MARYLAND
MAINE
MICHIGAN
MINNESOTA
MISSOURI
MISSISSIPPI
MONTANA
NORTH CAROLINA
NORTH DAKOTA
NEBRASKA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEVADA
NEW YORK
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VIRGINIA
VERMONT
WASHINGTON
WISCONSIN
WEST VIRGINIA
WYOMING
ZipCode
Day Phone
*
Mobile Phone
E-Mail
*
I do not have anytime to complete the rest of this form. Please have an agent call me.
Other Details
Have you had continuous coverage for at least 12 months?
Yes
No
If not, why not?
Present Auto Insurance Company
Renewal Date
Own Home?
Yes
No
Car #1
Year
Make
Model
2dr/4dr
Miles to Work(one way)
Annual Mileage
Type of Anti-Theft Device on Vehicle
VIN#
Car #2
Year
Make
Model
2dr/4dr
Miles to Work(one way)
Annual Mileage
Type of Anti-Theft Device on Vehicle
VIN#
Car #3
Year
Make
Model
2dr/4dr
Miles to Work(one way)
Annual Mileage
Type of Anti-Theft Device on Vehicle
VIN#
Driver#1 Information
Driver Name
Occupation
Business
Length at current job
Highest Level of Education
Date of Birth
Drivers License Number
Social Security Number
Gender
Male
Female
Marital Status
Single
Married
Divorced
Moving Violations in Last 3 Years
0
1
2
3
Please provide the date and a brief description of each violation
Accidents in Last 3 Years
0
1
2
3
Please provide the date and a brief description of each accident
Driver#2 Information
Driver Name
Occupation
Business
Length at current job
Highest Level of Education
Date of Birth
Drivers License Number
Social Security Number
Gender
Male
Female
Marital Status
Single
Married
Divorced
Moving Violations in Last 3 Years
0
1
2
3
Please provide the date and a brief description of each violation
Accidents in Last 3 Years
0
1
2
3
Please provide the date and a brief description of each accident
Driver#3 Information
Driver Name
Occupation
Business
Length at current job
Highest Level of Education
Date of Birth
Drivers License Number
Social Security Number
Gender
Male
Female
Marital Status
Single
Married
Divorced
Moving Violations in Last 3 Years
0
1
2
3
Please provide the date and a brief description of each violation
Accidents in Last 3 Years
0
1
2
3
Please provide the date and a brief description of each accident
Liability Limit for All Cars
Choose either Bodily Injury & Property Damage OR Single Limit
Bodily Injury
25,000/50,000
50,000/100,000
100,000/300,000
250,000/500,000
Property Damage
25,000
50,000
100,000
500,000
Single Limit
60,000
100,000
300,000
500,000
Levels of current Uninsured Motorist coverage
Car#1
Deductible Comprehensive
100
250
500
Deductible Collision
250
500
1000
Tow
Yes
Loss of Use
Yes
Car#2
Deductible Comprehensive
100
250
500
Deductible Collision
250
500
1000
Tow
Yes
Loss of Use
Yes
Car#3
Deductible Comprehensive
100
250
500
Deductible Collision
250
500
1000
Tow
Yes
Loss of Use
Yes
Comments
*
Mandatory field
FAQs
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Licensing,Disclaimer&Privacy Policy
A 2 year contestable and suicide provision applies on Life insurance contracts in most states. See product details for form number.
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