Get a Quote For Auto Insurance

Ames Insurance is an independent agency, which means we write insurance for many different companies.  By completing the questionnaire below you will give us the necessary information to offer you an accurate quote.

Complete this questionnaire completely for a free quote!  This form may also be used for motorcycles, snowmobiles, ATVs, boats, etc.  We will contact you for any additional information.

Vehicle information, vehicle #1:
Year Ex. 2006 Make
Model Serial # (VIN)
Usage? Number of miles one way?
Number of miles driven annually?  

Leased vehicle?
Does this vehicle have Air Bag(s)?
Does this vehicle have Anti-lock Brakes?
Does this vehicle have Day-time Running Lights?
Does this vehicle have an Anti-theft device?
What is your current Comprehensive deductible?
What is your Collision deductible?
Which Operator drives this vehicle most?
Vehicle information, vehicle #2:
Year Ex. 2006 Make
Model Serial # (VIN)
Usage? Number of miles one way?
Number of miles driven annually?  

Leased vehicle?
Does this vehicle have Air Bag(s)?
Does this vehicle have Anti-lock Brakes?
Does this vehicle have Day-time Running Lights?
Does this vehicle have an Anti-theft device?
What is your current Comprehensive deductible?
What is your Collision deductible?
Which Operator drives this vehicle most?
Vehicle information, vehicle #3:
Year Ex. 2006 Make
Model Serial # (VIN)
Usage? Number of miles one way?
Number of miles driven annually?  

Leased vehicle?
Does this vehicle have Air Bag(s)?
Does this vehicle have Anti-lock Brakes?
Does this vehicle have Day-time Running Lights?
Does this vehicle have an Anti-theft device?
What is your current Comprehensive deductible?
What is your Collision deductible?
Which Operator drives this vehicle most?
Vehicle information, vehicle #4:
Year Ex. 2006 Make
Model Serial # (VIN)
Usage? Number of miles one way?
Number of miles driven annually?  

Leased vehicle?
Does this vehicle have Air Bag(s)?
Does this vehicle have Anti-lock Brakes?
Does this vehicle have Day-time Running Lights?
Does this vehicle have an Anti-theft device?
What is your current Comprehensive deductible?
What is your Collision deductible?
Which Operator drives this vehicle most?

  Driver Information: Driver #1
  Full Name
  Sex
  Street Address
  City
  State
  Zip
  E-mail Address
  Telephone   Ex. 716-665-4100
  Fax   Ex. 716-665-4100
 
 
  Residence Occupancy
  Date of Birth   
  Age
  Marital Status
  Driver License / Permit Number  (9 digits)
  State Licensed
  Social Security Number
  Number of years Licensed
 
Driver training course completed? (if driver under age 25)
Defensive Driving Course completed within last 3 years?
Have you ever had a DWI, DUI, DWAI, etc.?
If yes, when?   
  Driver Information: Driver #2
  Full Name
  Sex
 
  Date of birth   
  Age
  Relationship
  Driver License / Permit number (9 digits)
  State Licensed
  Social Security number
  Number of years licensed
 
Driver Training course completed? (if driver under age 25)
Defensive Driving Course completed within last 3 years?
Have you ever had a DWI, DUI, DWAI, etc.?
If yes, when?   
  Other Licensed drivers in the household:
  Full Name
  DOB   
  Drivers License # (9 digits)
  Social Security #
  # Years Licensed

Current Insurance
Do you currently have an Auto insurance policy?
 
If "No" please skip to "How would you like us to contact you?"

What is the name of your current insurance company?
When does your policy expire?   
6 or 12 month policy?
What is your current premium?
What is your current "Bodily Injury Liability Limit?"
 
What is your current"Property Damage Liability Limit?"
 



Thank you for your information.

How would you like us to contact you? 

Additional Comments: (e.g. additional driver info, additional vehicle info)