CT Auto Insurance Quote.com
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CT auto insurance discounts
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save money on your CT car insurance! "Thanks again RiteQuote Insurance - you saved me over $100 per month on my auto insurance! I recommend you to ANYONE with driving record issues."
(Jamie T., Bristol, CT)
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"I couldn't believe it when I called you, got an instant quotation on the phone, and had my proof of insurance within just a couple hours. When you said "Low Cost Auto Insurance" you were not kdding - You're the best!"
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"After I got a drunk driving violation I thought I was finished and that my insurance would be unaffordable. What a surprise to find a policy from you for nearly what I was paying!"
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"My sister told me about this web site because I could not get my parents' insurance agent to even call me back. You got me Low Cost Auto Insurance (full coverage too!) on my car at a super-low rate! Thanks again - what a great service".
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« Online Quick Quote »
On-Line Connecticut Automobile
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!

(For More Than One Car or Driver, CLICK HERE)


Your Personal Data

Your Name:
Street Address:
City:
State (Must be Connecticut):
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Marital Status:
Single Married
Homeowner?
Yes No
 
Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)


DRIVER INFORMATION #1
Name: Birthdate:
Sex (M/F): # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Daily commute
in ONE WAY miles:
Does Driver need
an SR22 FILING?
Yes No If YES to SR22 filing, why needed?
(list accident/cite)


VEHICLE #1 INFORMATION
(if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
Year of vehicle: Make & Model:
Vehicle ID# (for rating accuracy):
Annual Mileage: Used in business?
(Explain, if yes):
VEHICLE #1 COVERAGES:
Select Liability Limits
 
Select Comprehensive Deductible
(inlcudes full glass):
 
Select Collision Deductible:
 
Rental Car &
Towing Coverage?
YES NO
 
Medical Coverage? YES NO
 
 
Comments or Remarks:
(List additional drivers, autos, etc. here)
If More than 2 Vehicles or Drivers, list Additional Vehicles Year, Makes, and Models, and Driver's Ages and Driving records here:


Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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CT Auto Insurance Quote.com
A Service of RiteQuote Insurance Agency, LLC
Phone: 860-585-8144 / Toll-Free: 855-748-3786 / Fax: 860-585-1946
E-Mail us at: ritequote@yahoo.com
Home Office: 258 Middle Street - Bristol, CT 06010