Auto Quote


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70 Sullivan Street, Berwick ME 03901, Tel. (207) 698-1513

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Automobile Quote - Up to 4 Drivers and 2 Vehicles

The quotes provided here are for NH only.
Fill out the form below to obtain a New Hampshire auto quote. To obtain a Maine quote, use our Maine Auto Quote form. All red fields are required. Be careful to include their information before submitting your form. You may add up to 4 drivers and 2 vehicles on this quote form. For additional vehicles or drivers, feel free to call us.
The quotes provided here are for NH only.
Vehicle(s) Registration Information Section The name and address to which the vehicle(s) is or will be registered:
Name:
Street:
City/State/Zip:	/ /
Home Phone:	Work Phone:
Email Address:
Driver Information Section Review Sections:
State Licensed:	Driver 1
	Driver 2
	Driver 3
	Driver 4
Years of Driving Experience:	Driver 1
	Driver 2
	Driver 3
	Driver 4
If less than 3 years, have you completed a course in Driver Training?	Driver 1
	Driver 2
	Driver 3
	Driver 4
Drivers License Number:	Driver 1
	Driver 2
	Driver 3
	Driver 4
Date of Birth	Driver 1
	Driver 2
	Driver 3
	Driver 4
Has driver had any at-fault accidents or moving violations in the past six (6) years?	Driver 1
	Driver 2
	Driver 3
	Driver 4
If yes, please give a brief description:	Driver 1
	Driver 2
	Driver 3
	Driver 4

Vehicle Information Section Review Sections:
Year	Vehicle 1
Year	Vehicle 2
Make	Vehicle 1
Make	Vehicle 2
Model (Please be as specific as possible. ie. Honda Accord LX, 4 door)	Vehicle 1
	Vehicle 2
City Primarily Garaged:	Vehicle 1
City Primarily Garaged:	Vehicle 2
Please check all that apply to this vehicle.
Airbags	Vehicle 1
Airbags	Vehicle 2
Automatic Seatbelts	Vehicle 1
Automatic Seatbelts	Vehicle 2
Drive to Work Distance (miles)	Vehicle 1
Drive to Work Distance (miles)	Vehicle 2
Antitheft device (Alarm)	Vehicle 1
Antitheft device (Alarm)	Vehicle 2

Insurance Coverages Section Review Sections:
Compulsory Insurance (Mandatory)
	Bodily Injury to Others:	Vehicle 1
		Vehicle 2
	Medical Payments:	Vehicle 1
		Vehicle 2
	Bodily Injury caused by uninsured auto:	Vehicle 1
		Vehicle 2
	Bodily Injury caused by underinsured:	Vehicle 1
		Vehicle 2
	Damage to someone else's property:	Vehicle 1
		Vehicle 2
Optional Insurance
	Collision Coverage Deductible:	Vehicle 1
		Vehicle 2
	Comprehensive Coverage Deductible:	Vehicle 1
		Vehicle 2
	Substitute Transportation:	Vehicle 1
		Vehicle 2
	Towing and Labor:	Vehicle 1
		Vehicle 2
End of Form Review Sections: Select Response Method, then click the Submit button below
Response Method
I would like my quote sent to me via:
Fax Number:
Mailing Address:		Street:
		City/State/Zip:	/ /

How did you hear of us? Other:

Comments:

We will send your quote promptly.
Thank you for considering Goodrich Insurance!