"Purchase a Home Policy & $ave More" "Extra $avings for Family Policies"

 

                Free                             No Hassle                        No Obligation                     Quote              

                                                                 Auto Insurance Quote                                                           

Completing our online quote request form is easy !!
Complete our easy online quote request form, and we will do the rest. Upon receiving your request, our licensed agents will do all the price shopping for you, by selecting the most competitive rates and reputable companies. You will receive your online quote instantly and accurately based on the information you provide. When you are ready to start your insurance, contact us and one of our licensed agents will set you up right away.

Our Privacy Policy
We want you to know that we respect your privacy; and we protect your information. We do not sell customer or prospect information. We do not share your information with persons, companies, or organizations outside of Fariņas Insurance that would use that information to contact you about their products and services. We keep all your information confidential. We convey to our employees about the need to protect your information. 

We're here to help
If you would like to speak directly to one of our licensed agents, please feel free to contact us.

 

            Client Information
First Name:
Last Name:
Street:
City:
State:
Zip:
Daytime Phone with Area Code:
Evening Phone with Area Code:
Fax Number:
Email:
Current Policy with:
Date Policy Expires:
Years of Continuous Insurance:
   

          Vehicle Information
Year of Vehicle #1:
Make of Vehicle #1:
Model of Vehicle #1:
Bodily Injury Liability Limits:
Property Damage Liability Limits:
Uninsured Motorist Bodily Injury Limits:
Uninsured Motorist Property Damage or Collision Deductible Waiver: Yes No
Medical Payments:
Rental Reimbursement: Yes No
Towing: Yes No
Roadside Assistance:
Comprehensive:
Collision:
   

       Please List Additional Vehicles Below

      If No Additional Vehicles Are Desired Please Click Here
Year of Vehicle #2 :
Make of Vehicle #2 :
Model of Vehicle #2 :
Bodily Injury Liability Limits:
Property Damage Liability Limits:
Uninsured Motorist Bodily Injury Limits: 
Uninsured Motorist Property Damage or Collision Deductible Waiver:  Yes No
Medical Payments:
Rental Reimbursement: Yes No
Towing: Yes No
Roadside Assistance:
Comprehensive:
Collision:
   
Year of Vehicle #3 :
Make of Vehicle #3 :
Model of Vehicle #3 :
Bodily Injury Liability Limits:
Property Damage Liability Limits:
Uninsured Motorist Bodily Injury Limits: 
Uninsured Motorist Property Damage or Collision Deductible Waiver:  Yes No
Medical Payments:
Rental Reimbursement: Yes No
Towing: Yes No
Roadside Assistance:
Comprehensive:
Collision:
 
Year of Vehicle #4 :
Make of Vehicle #4 :
Model of Vehicle #4 :
Bodily Injury Liability Limits:
Property Damage Liability Limits:
Uninsured Motorist Bodily Injury Limits: 
Uninsured Motorist Property Damage or Collision Deductible Waiver:  Yes No
Medical Payments:
Rental Reimbursement: Yes No
Towing: Yes No
Roadside Assistance:
Comprehensive:
Collision:
   
Year of Vehicle #5 :
Make of Vehicle #5 :
Model of Vehicle #5 :
Bodily Injury Liability Limits:
Property Damage Liability Limits:
Uninsured Motorist Bodily Injury Limits: 
Uninsured Motorist Property Damage or Collision Deductible Waiver:  Yes No
Medical Payments:
Rental Reimbursement: Yes No
Towing: Yes No
Roadside Assistance:
Comprehensive:
Collision:
 

               Driver Information
Name of Driver #1:
Date of Birth:
Years Licensed:
Marital Status:
Gender:
Vehicle Usage:
Minor violations in last 3 yrs:
Major violations in last 7 yrs:
Accidents in last 3 yrs:
 
 

                                            Please List Additional Drivers Below

                                  If No Additional Drivers Are Desired Please Click Here
Name of Driver #2:
Date of Birth:
Years Licensed:
Marital Status:
Gender:
Vehicle Usage:
Minor violations in last 3 yrs:
Major violations in last 7 yrs: 
Accidents in last 3 yrs:
   
Name of Driver #3:
Date of Birth:
Years Licensed:
Marital Status:
Gender:
Vehicle Usage:
Minor violations in last 3 yrs:
Major violations in last 7 yrs: 
Accidents in last 3 yrs:
   
Name of Driver #4:
Date of Birth:
Years Licensed:
Marital Status:
Gender:
Vehicle Usage:
Minor violations in last 3 yrs:
Major violations in last 7 yrs: 
Accidents in last 3 yrs:
   
Name of Driver #5