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Auto Coverage Florida


Please complete the form below and we will email you the best of quotes with Travelers, The Hartford, Safeco, MetLife Auto and Progressive.

Please note that we are a Preferred Coverage Agency, meaning that we have excellent value for Insureds with good driving records and carrying high limits of coverage.  If you do not have prior insurance or want state minimum coverage we can refer you to an agency that has competitive companies for you. 


First Name
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Last Name
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Street
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City
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State
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ZIP / Postal Code
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Primary Phone Number
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E-Mail Address
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Accidents or Violations? Please Explain
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Additional Comments
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Ages of Children (separated by commas)
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Coverage Options
Coverage Period
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Do you rent or own your home?
Optional
Do you use this vehicle for business or school?
Required
Does this driver have any major violations (5yrs), accidents or minor violations (3yrs), comprehensive or collision claims (3yrs)?
Required
Does this driver have any major violations or claims in the last five years?
Optional
Drive vehicle 1 to school or work?
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Drive vehicle 2 to school or work?
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Drive vehicle 3 to school or work?
Optional
Drive vehicle 4 to school or work?
Optional
Driver Information
E-Mail Address
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Effective Date
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/ /
How did you hear about us?
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Liability Limit
Optional
Property Damage Liability
Required
Towing
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Uninsured Motorist Bodily Injury
Optional
Vehicle #1
Optional


Vehicle 1 - Average Commute in Miles
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Vehicle 1 - Collision Deductible
Optional
Vehicle 1 - Comprehensive Deductible
Optional
Vehicle 1 - Towing
Optional
Vehicle 1 Make
Required
Vehicle 1 Model
Required
Vehicle 1 VIN
Optional
Vehicle 1 Year Model
Required
Vehicle 1- Rental
Optional
Vehicle #2
Optional


Vehicle 2 - Average Commute in Miles
Optional
Vehicle 2 - Collision Deductible
Optional
Vehicle 2 - Comprehensive Deductible
Optional
Vehicle 2 - Towing
Optional
Vehicle 2 Make
Required
Vehicle 2 Model
Required
Vehicle 2 VIN
Optional
Vehicle 2 Year Model
Required
Vehicle 2- Rental
Optional
Vehicle #3
Optional


Vehicle 3 - Average Commute in Miles
Optional
Vehicle 3 - Collision Deductible
Optional
Vehicle 3 - Comprehensive Deductible
Optional
Vehicle 3 - Towing
Optional
Vehicle 3 Make
Optional
Vehicle 3 Model
Required
Vehicle 3 VIN
Optional
Vehicle 3 Year Model
Required
Vehicle 3- Rental
Optional
Vehicle #4
Optional


Vehicle 4 - Average Commute in Miles
Optional
Vehicle 4 - Collision Deductible
Optional
Vehicle 4 - Comprehensive Deductible
Optional
Vehicle 4 - Towing
Optional
Vehicle 4 Make
Optional
Vehicle 4 Model
Required
Vehicle 4 VIN
Optional
Vehicle 4 Year Model
Required
Vehicle 4- Rental
Optional
Will there be any drivers under 21 on this policy?
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Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
Wiglesworth - Rindom Insurance Agency | 5300 W. Atlantic Ave; Suite 604 - Delray Beach, FL 33483 | 217 SW Akron Ave - Stuart, FL 34994 |
Phone: 561.637.2424
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