564 Center Street Ludlow, MA

  413-583-6424

Hours:

Mon-Fri

8:30 to 5:3o

Sat 9:00 to 12:00

 

Automobile Insurance Quote Form

First Name  
Last Name  
License #:  
Date of Birth:  
Address  
   
State  
City  
Zip  
Home Phone  
Cell Phone  
E mail  
Garaging  
Years at current address  
Vehicle Year  
    Make  
    Model  
     VIN #  
Air Bags   Yes
No
Antitheft Device   Yes
No
Hybrid   Yes
No
Miles Driven per year  
Company  
    Years with Company  
Own Home   Yes
No
    Home Insured   Yes
No
AAA membership #:  

    Member since:

     COVERAGES

 

 

Uninsured Bodily Injury  
Property Damage  
Optional Bodily Injury  
Medical Payments  
Collision Deductible  
Comprehensive Deductible  
Rental   $30 per Day
$45 per Day
Towing and Labor:  
Underinsured Bodily Injury  
# of Drivers on policy  

THANK YOU

HOME   QUOTES ABOUT US   HELPFUL LINKS CONTACT US

 

Copyright © 2011 Leitao Insurance. All rights reserved. Website Developed by Website Concepts