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Home > Automobile Quote Form

Automobile Quote Form

You can request a quote by completing the following form and clicking the "Send Quote" button to submit. Please note that we retrieve quote and service requests periodically during the day. We will get back to you no later than the next business day.

A copy of your current policy is the best way to receive a complete and accurate quote. Email a copy to info@keefeins.com or fax to 508-528-3887.

DISCLAIMERS:
Quotes are computed to the best of our ability based on the information provided. If the information is incomplete or incorrect, your actual quote may change. Please refer to the information on your current policy when filling out this request.

Please note that we can only provide quotes for residents of Massachusetts. Please also note that no coverage can be legally bound by E-mail or Fax. Thank you.

Your Name

* = Required information

*First
*Last

Your Contact Information
*Address
*City
*State
*Zip Code
*Daytime Phone
Residence Phone
E-mail Address

Driver Information
*Driver #1 Name:
*Years of Driving Experience
*Driver Training? Yes No
*Drivers License #
*Student maintaining B avg or better:
*Student 100+ miles from home:
*Name of School
*Any accidents or violations in the last three years?

 
Driver #2 Name:
Years of Driving Experience
Driver Training? Yes No
Driver License #
*Student maintaining B avg or better:
*Student 100+ miles from home:
*Name of School
Any accidents or violations in the last three years?

 
Driver #3 Name:
Years of Driving Experience
Driver Training? Yes No
Driver License #
*Student maintaining B avg or better:
*Student 100+ miles from home:
*Name of School
Any accidents or violations in the last three years?

 

First Vehicle Info
*Year, Make, and Model of Vehicle:
*Body Type:
Low Mileage Discount:
Anti-Theft Device:
Air Bag(s)?
*License Plate Number:
*Vehicle ID Number:

 

Coverages Desired:
Bodily Injury Liability:
Collision Coverage Deductible:
Comprehensive Coverage Deductible:
Substitute Transportation:
Towing and Labor:

 

Second Vehicle Info (Optional)
Year, Make, and Model of Vehicle:
Body Type:
Low Mileage Discount:
Anti-Theft Device:
Air Bag(s)?
License Plate Number:
Vehicle ID Number:

 

Coverages Desired:
Bodily Injury Liability:
Collision Coverage Deductible:
Comprehensive Coverage Deductible:
Substitute Transportation:
Towing and Labor:

 
Other comments/questions:

 
clr (1K)

©2007, Keefe Insurance Agency, Inc. 51 West Central Street (Route 140) Franklin, MA 02038.
Phone: 508-528-3310 — Toll-Free: 888-528-3310 — Fax: 508-528-3887 — E-mail: info@keefeins.com

Privacy Statement & Disclaimer. NOTE: No coverage can be legally bound by E-mail or Fax. Policies and coverages are presented in general terms; consult insurance policies for coverage specifics and contract terms. Site by MullaneyCookson Marketing.