Metro Insurance Service's Free Online Quote Form for Automobile or Motorcycle Insurance

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Metro Insurance Online Quote Form

*Last Name:
*First Name:
*Street Address:
*City:
*County:
*State:
*Garaging Zip Code:
*Email:
*Phone Number:
Number of Vehicles:

Note: You must complete all * fields so that the Metro Insurance Staff can get in touch with you concerning your free online quote.

Vehicle Information:

Vehicle # 1		Vehicle # 2		Vehicle # 3
Year		Year		Year
Make		Make		Make
Model		Model		Model

Select all that apply from the following list:

Vehicle # 1		Vehicle # 2		Vehicle # 3
	4 Wheel Drive		4 Wheel Drive		4 Wheel Drive
	Turbo		Turbo		Turbo
	Leased		Leased		Leased
	Anti-Lock Brakes		Anti-Lock Brakes		Anti-Lock Brakes
	Anti-Theft		Anti-Theft		Anti-Theft
	Automatic Seat Belt		Automatic Seat Belt		Automatic Seat Belt

Vehicle Usage: (Select all that apply):

Vehicle # 1

Vehicle # 2

Vehicle # 3

	pleasure		pleasure		pleasure
	to work		to work		to work
	business		business		business

Coverages (Choose One from each group):

Liability:

Vehicle # 1

Vehicle # 2

Vehicle # 3

	25/50/20		25/50/20		25/50/20
	50/100/25		50/100/25		50/100/25
	100/300/50		100/300/50		100/300/50

Physical Damage (Comprehensive/Collision):

Vehicle # 1

Vehicle # 2

Vehicle # 3

	100/250		100/250		100/250
	250/250		250/250		250/250
	100/500		100/500		100/500
	250/500		250/500		250/500
	500/500		500/500		500/500
	towing $25.00		towing $25.00		towing $25.00
	rental		rental		rental

Medical Expenses:

Vehicle # 1

Vehicle # 2

Vehicle # 3

	1,000		1,000		1,000
	2,000		2,000		2,000
	5,000		5,000		5,000

Number of Drivers

Driver # 1

Driver # 2

Driver # 3

Age		Age		Age
Marital Status		Marital Status		Marital Status
Sex		Sex		Sex
# of years licensed in US?		# of years licensed in US?		# of years licensed in US?
Driver's Education?		Driver's Education?		Driver's Education?

**Driver History**
(Need tickets and accidents that occurred in the past three (3) years with approximate dates)

Driver # 1

Driver # 2

Driver # 3

Discounts

	Yes	No
Do you have car insurance in force now?
Has it been in force for at least 6 months?
Do you own a home?
Is it a mobile home?
Do you wish to pay in full?

Answer the following questions if you are inquiring about motorcycle insurance.

	Yes	No
Do you have motorcycle insurance now?
Are you a member of any rider groups?
Have you taken the motorcycle safety course within the past 3 years?
How many years of on the road bike experience do you have?
How many years of off road bike experience do you have?
How long have you had a drivers license?
Do you keep your bike in a lockable structure?

Any questions or comments, enter them here.