Auto Insurance

Although most people do not think about their coverage until after they had a loss, there is a strategy to consider when selecting your coverage. Insurance should help you deal with those losses that you can not handle on your own. For example, carrying more Bodily Injury coverage which pays on your behalf if you injure someone in an accident may protect you from a larger financial loss than than carrying a smaller Comprehensive and Collision Deductible. (Double your coverage without doubling your premium)

We offer discounts when your home is insured with us and if you insure more than one vehicle. Discounts are also offered for many professionals. We also have a youthful driver discount up to 25% for young drivers that complete a video and workbook on safe driving. These young drivers can also qualify for a good student discount with a "B" or better average. We can help you determine the proper amount of coverage as well help you design a plan that works for your specific needs.

Please let us know if you want the proposal faxed or e-mailed. If you have any questions, please call us at (661) 775-9244 or e-mail jon@jongardnerinsurance.com

Your Name
Contact Name
Email Address (required)
Address (where cars are kept)
City (where cars are kept)
State (where cars are kept)
Zip (where cars are kept)
Telephone
Fax
Your preferred contact method

 

About the drivers:

	Gender	Married	D.O.B			Drivers License #
Primary	Select Male Female	Select Married Single	Mth Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	Year 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932
Spouse	Select Male Female	Select Married Single	Mth Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	Year 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932
Driver 3	Select Male Female	Select Married Single	Mth Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	Year 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932
Driver 4	Select Male Female	Select Married Single	Mth Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	Year 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932

 

About driving records:

Include all tickets where you did not go to traffic school and all accidents that were your fault. Please list any major citations in the "other" section below.
	From 0-3 Years Old		From 3-6 Years Old
Driver	Tickets	Accidents	Tickets	Accidents
Select You Driver2 Driver3 Driver4	Select 0 1 2 3	Select 0 1 2 3	Select 0 1 2 3	Select 0 1 2 3
Select You Driver2 Driver3 Driver4	Select 0 1 2 3	Select 0 1 2 3	Select 0 1 2 3	Select 0 1 2 3
Select You Driver2 Driver3 Driver4	Select 0 1 2 3	Select 0 1 2 3	Select 0 1 2 3	Select 0 1 2 3
Select You Driver2 Driver3 Driver4	Select 0 1 2 3	Select 0 1 2 3	Select 0 1 2 3	Select 0 1 2 3
Other (include all major citations  (e.g. DUI or reckless driving)

 

About your vehicles:

	Include Year, Make, Model, Trimline (e.g. LX or EX), # of doors (2-dr or 4-dr)	Primary Driver
Vehicle #1:		Select You Driver2 Driver3 Driver4
Vehicle #2:		Select You Driver2 Driver3 Driver4
Vehicle #3:		Select You Driver2 Driver3 Driver4
Vehicle #4:		Select You Driver2 Driver3 Driver4

 

Coverage desired:  (click here for a description of the coverages)

Bodily Injury	Select 15/30 50/100 100/300 250/500
Property Damage	Select 10,000 25,000 50,000 100,000
Uninsured Motorist	Select 10,000 25,000 50,000 100,000
Medical Coverage	Select None 2,000 10,000 25,000
	Vehicle 1	Vehicle 2	Vehicle 3	Vehicle 4
Comprehensive	Select 240 500 1,000 1,250 2,500	Select 240 500 1,000 1,250 2,500	Select 240 500 1,000 1,250 2,500	Select 240 500 1,000 1,250 2,500
Collision	Select 240 500 1,000 1,250 2,500	Select 240 500 1,000 1,250 2,500	Select 240 500 1,000 1,250 2,500	Select 240 500 1,000 1,250 2,500
Rental	Select None 25/day 50/day	Select None 25/day 50/day	Select None 25/day 50/day	Select None 25/day 50/day
Towing & Road Service	Select Yes No	Select Yes No	Select Yes No	Select Yes No

 

About driving distance:

Vehicle	One-way miles to work/school	# of days per week	Annual miles
Vehicle #1
Vehicle #2
Vehicle #3
Vehicle #4

 

Current premium paid		Per	Select Month 3 months 6 months Year
Current insurance company
Renewal date

Additional Comments: