Other than the insurance you have purchased from our agency, do you have any additional policies with another insurance company or independent agency?
a. If yes, check all that apply and provide the name of the insurance company (not the agency) on your policies
Please provide the vehicle information for the vehicle on your auto policy. If you have more than one vehicle on the this policy please contact us.
Are you a member of AAA Motor Club or Other Motor Club??
Do you have an SBLI life insurance policy? (an auto insurance premium discount may be available to SBLI life insurance policy holders, this information will not be used to contact you for any sales or marketing purpose.)
Are you or any of the drivers on your policy inexperienced operators (drivers licensed less than 6 years)?
If yes, complete questions #6-#8
If no, skip to question #9
Have any of the inexperienced operators on your policy completed a certified Advanced Driver Training course?
a. If yes, please indicate course taken and provide a certificate of course completion.
Has the inexperienced operators on your policy, if any, achieved "Good Student" status for academic performance per the following guidelines?
Must be High School, Vocational School, College or University Student who is:
Are any inexperienced operators listed on your auto policy currently away at a school more than 100 road miles from your residence (principal place of garaging) without regular access to operate your insured vehicles?
If yes, please provide the inexperienced operator Name(s) and School(s) attending
- Does anyone in your home utilize public transportation?
a. If yes, please provide Name of approved public Transit System:
*Business Use is NOT eligible. Must submit a minimum of 11 consecutive months of passes/tickets and proof of purchase for refillable/pre-paid passes.
(i.e. Charlie Card-copy of bank statement showing charges)
Would you like to receive quotes for optional coverage offered by some insurers for additional premium charges? (refer to our Frequently Asked Questions for detailed descriptions at http://www.renaissanceins.com/ma-auto-faqs/ )
Are there any other insurance needs we can help you with now or that you anticipate next year?
Please be advised that insurance coverage cannot be bound, modified, or terminated by e-mail messages or information provided to us via the web. Any information you submit will be used solely for the purpose of quoting insurance options, and does not in any way constitute an agreement of coverage.