Durkin & DeVries Insurance: Multiple Vehicle Quotation Form

For an Auto insurance quote for more than one vehicle simply fill out the form below and click the submit button. One of our agents will contact you to review a personalized quotation within 24 hours. If you have any questions regarding the coverage in general, please feel free to contact us.

This form requires you to submit a minimum of two vehicles. For one vehicle, please fill out our quote for one vehicle form.

Personal Info

First Name:

Last Name:

Address:

City:

State:

Zip Code:

E-mail:

Telephone:

Fax:

Best time to call:

Driver Information

	First Name	Last Name	Date of Birth (mm/dd/yy)	License Number	State
Driver 1
Driver 2
Driver 3
Driver 4

Vehicle 1

Year:

Make:

Model:

Vehicle I.D. #:

Annual Mileage:

Airbag/Automatic Seatbelt?

Yes No

Anti-theft device?

Yes No

Lojack device?

Yes No

Age 65 and older?

Yes No

Transit or T-pass Discount?

Yes No

Vehicle 1 Deductibles:

Part 7 - Collision (deductible):

Part 8 - Limited Collision:

Part 9 - Comprehensive (deductible):

Part 10 - Transportation:

Part 11 - Towing and Labor:

Vehicle 2

Year:

Make:

Model:

Vehicle I.D. #:

Annual Mileage:

Airbag/Automatic Seatbelt?

Yes No

Anti-theft device?

Yes No

Lojack device?

Yes No

Age 65 and older?

Yes No

Transit or T-pass Discount?

Yes No

Vehicle 2 Deductibles:

Part 7 - Collision (deductible):

Part 8 - Limited Collision:

Part 9 - Comprehensive (deductible):

Part 10 - Transportation:

Part 11 - Towing and Labor:

Vehicle 3

Year:

Make:

Model:

Vehicle I.D. #:

Annual Mileage:

Airbag/Automatic Seatbelt?

Yes No

Antitheft device?

Yes No

Lojack device?

Yes No

Age 65 and older?

Yes No

Transit or T-pass Discount?

Yes No

Vehicle 3 Deductibles:

Part 7 - Collision (deductible):

Part 8 - Limited Collision:

Part 9 - Comprehensive (deductible):

Part 10 - Transportation:

Part 11 - Towing and Labor:

Vehicle 4

Year:

Make:

Model:

Vehicle ID #:

Annual Mileage:

Airbag/Automatic Seatbelt?

Yes No

Antitheft device?

Yes No

Lojack device?

Yes No

Age 65 and older?

Yes No

Transit or T-pass Discount?

Yes No

Vehicle 4 Deductibles:

Part 7 - Collision (deductible):

Part 8 - Limited Collision:

Part 9 - Comprehensive (deductible):

Part 10 - Transportation:

Part 11 - Towing and Labor:

Coverage Options For All Cars:

Part 1 - Bodily Injury to others:

$20,000/$40,000

Part 2 - Personal Injury Protection:

$8,000

Part 3 - Uninsured Motorist:

Part 4 - Property damage:

Part 5 - Optional Bodily Injury:

Part 6 - Medical Payments:

Part 12 - Underinsured Motorist:

Submitting an insurance quotation request to Durkin & DeVries Insurance does not constitute a binding contract of new or altered insurance coverage. Verbal or written confirmation must be obtained from Durkin & DeVries Insurance to confirm binding or altering coverage.