Auto Quote Form - Berks County, Reading, PA

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Drivers

Driver 1

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Driver 2

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Driver 3

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Driver 4

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Add Fifth Driver

Yes

Driver 5

Name*

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Any accidents or violations in the last 5 years (date and activity)

Vehicles

Vehicle 1

Year*

Make*

Model*

VIN*

Titled To*

Usage*

Daily Mileage*

Employer/School*

This vehicle is used to rideshare? (uber, lyft)*

Yes

Add Second Vehicle

Yes

Vehicle 2

Year*

Make*

Model*

VIN*

Titled To*

Usage*

Daily Mileage*

Employer/School*

This vehicle is used to rideshare? (uber, lyft)*

Yes

Add Third Vehicle

Yes

Vehicle 3

Year*

Make*

Model*

VIN*

Titled To*

Usage*

Daily Mileage*

Employer/School*

This vehicle is used to rideshare? (uber, lyft)*

Yes

Add Fourth Vehicle

Yes

Vehicle 4

Year*

Make*

Model*

VIN*

Titled To*

Usage*

Daily Mileage*

Employer/School*

This vehicle is used to rideshare? (uber, lyft)*

Yes

Add Fifth Vehicle

Yes

Vehicle 5

Year*

Make*

Model*

VIN*

Titled To*

Usage*

Daily Mileage*

Employer/School*

This vehicle is used to rideshare? (uber, lyft)*

Yes

Current Insurance Coverage

Current Insurance Carrier

Current Coverage Policy Level:

Tort*

Bodily injury*

Property Damage*

Medical Expense*

Income Loss*

Accidental Death*

Funeral Benefit*

Extraordinary Medical Benefit*

Underinsured Motorist*

Uninsured Motorist*

Current Coverages by Car:

Comprehensive*

Collision*

Rental Car*

Road Service*

Gap Insurance*

Diminishing Deductible*

Did you know National Cookie Exchange Day is on December 22? It’s the perfect time of year for this holiday — and we’ve got the perfect recipe for any upcoming cookie exchanges!

Try these quick and delicious eight-ingredient Chocolate and Peanut Butter No-Bake Cookies.

Planning to use this recipe? Share your cookie photos in the comments! Or add your own favorite cookie recipe – we’d love to hear it 🍪 ... See MoreSee Less