Excerpted from "Auto Insurance Tricks & Repair Rip-Offs" Copyright 1994-1998 by Ron Alford
R.F.P.
REQUEST FOR PROPOSAL
Date __________________
Dear Insurance Agent:
I am interested in receiving a quote from you to insure a vehicle that I now own or am about to purchase. Please take careful notice that for each driver of this vehicle, I have submitted a separate “Driver Information Form.” If there are no other driver information forms attached, then I am the only driver that will drive this vehicle during the policy period unless my situation changes. Please complete the form in its entirety. A blank line will indicate to me that you do not offer this coverage. To assist in getting a prompt reply, you can fax your quote to me at ( ______ ) _ _________________.
If you have any questions, I invite your call and I look forward to your prompt response.
Respectfully submitted,
_________________________
Mr. Mrs. Ms. Dr. Last ______________________ First _______________ Initial ____
Address _________________________________________________
City __________________________ State _____ Zip ___________
Phone: Day ( ) ______ ________ Eve ( ) _______ _________
SSN ___ ___ ____ [ ] Male [ ] Female DOB ___/ ___/ ___
My ______ State Drivers License No. is ______________________
Age first Licensed ____ Single [ ] Divorced [ ] Married [ ]
Occupation ______________________________________________
I am presently insured with ______________________ Insurance Co.
My present insurance expires on ___/___/ ____.
I expect to drive this vehicle _________ percent of the time insured.
I drive this vehicle ____________ miles one way to work daily.
Last year I drove a total of _________ miles.
I expect to drive this vehicle _________ miles during the next 12 months.
I do / do not use this vehicle for business purposes.
I have had driver training in the last 3 years. [ ] Y [ ] N
I have had [ ] vehicles stolen in the last 5 years.
I have been involved as a driver in [ ] accidents in the last 5 years.
I have been given [ ] traffic violations in the last 5 years.
I have ____ points on my license.
I have worked at my present job for [ ] years.
I [ ] Own my home [ ] Rent [ ] Live with parents [ ].
Year _____ Make ________________________________________
Model ___________________ Sub Model ____________________
Vehicle ID #____________________________________________
[ ] 2 door [ ] 4 door [ ] Van
[ ] Pickup [ ] Convertible [ ] Other _______________________
This vehicle is equipped with [ ] Driver air bag [ ] Passenger air bag
[ ] Automatic Seat Belts [ ] Anti Theft Device [ ] Passive Alarm
[ ] Anti lock brakes [ ] Alarm system: ______________________
[ ] Other _______________________________________________
At night vehicle is kept [ ] on street [ ] driveway [ ] carport [ ] garage
Its current odometer reading is _______________________________
I have current photos of this vehicle to attest to these statements Y N
This vehicle does / does not have damages valued at more than $200.00.
Comments:
Based on the information above, please quote prices on each of the coverages below. I will choose the coverage I want after a price for each has been quoted. If you do not sell insurance as written, please mark each coverage N/A (not available).
General Liability
10/20/5 ------------------------------ $ _____________________
20/40/20 ---------------------------- $ _____________________
50/100/50 --------------------------- $ _____________________
100/300/50 -------------------------- $ _____________________
Un insured Motorist
10/20/5 ------------------------------ $ _____________________
20/40/20----------------------------- $ _____________________
50/100/50---------------------------- $ _____________________
100/300/50-------------------------- $ _____________________
Under insured Motorist
10/20/5------------------------------ $ _____________________
20/40/20 ---------------------------- $ _____________________
50/100/50 ---------------------------- $ _____________________
100/300/50--------------------------- $ _____________________
Personal Injury Protection
Circle one
$50,000, $100,000, $300,000, $500,000 $ __________________
Physical Damage
Deductible Circle only one:
Collision - $500/$1,000 deductible $ __________________
Full glass coverage / no deductible $ __________________
Comprehensive - $250 /500 /$1,000 ded. $ __________________
Towing and labor / $50 per occurrence $ __________________
Rental reimbursement / $____ daily $ __________________
Stated value in the amount of $ _____ __________________
Cut along this line before sending to the agents
CUT ____________________________Cut along this line _____________________________CUT
When you have obtained WRITTEN not VERBAL quotes from 4 insurance companies, you can insure that your insurance company will perform as expected by having your four candidates rated by how they treat claimants and pay claims.
Click Here To find out how these companies treat you as a victim.
- Disaster Masters - The Plan Publishing Company- Quality Information Institute - The Consumer's Action Plan-