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AUTOMOBILE INSURANCE QUOTATION FORM

To help us supply you with the most accurate quote possible, please answer as many questions as you can with the most accurate information available to you. Information submitted will be held confidential and will be used for quote purposes only. Submission of application information in no way obligates you to purchase any product or insurance, nor does it represent any agreement to provide coverage under any insurance policy.
Auto Insurance New York Karis and Karis
Homeowners insurance New York Karis and Karis
* Required fields.

Personal Information

Full Name *

Address
City
State
Zip

Daytime Phone Number *
Night Phone Number *
Cell Phone

Email Address *
Confirm Email Address *

Current Auto Insurance Information

Company Name (not agency)

Policy Expiration Date
Premium Amount

Policy Term 6 Months 1 Year

Years Insured

Vehicle Information
(All cars you or your family members own or lease)


Car #1 Year Make Model Body
Car #2 Year Make Model Body
Car #3 Year Make Model Body
Car #4 Year Make Model Body

Liability Limit For ALL Cars

Choose Either Bodily Injury and Property Damage OR Single Limit

Bodily Injury
Property Damage
OR
Single Limit

Deductibles

Car #1 Comprehensive
Collision Towing? Loss of Use?

Car #2 Comprehensive
Collision Towing? Loss of Use?

Car #3 Comprehensive
Collision Towing? Loss of Use?

Car #4 Comprehensive
Collision Towing? Loss of Use?

Umbrella Liability

Personal Umbrella Coverage Yes No
Amount

Message or Comments


Please click the "Send" button to send your free quote request. This is a request for quotation only.

Commercial Insurance Business Insurance New York Karis and Karis
Directions to Karis and Karis Insurance Agency
Auto Insurance
No previous coverage necessary
Multi-policy discounts
Bad or no credit
Bad driving record
Auto Insurance

Homeowners Insurance
High Value
Coastal
Tenant Occupied
Vacant
Up to 6 Family
Homeowners Insurance

Business/Commercial Insurance
Apartment Buildings
Contractors
Gas Stations
Deli's
Restaurants
Business Owners
Business/Commercial Insurance

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