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Auto Insurance Quote Form (New York State Only)

Please complete the following form and click the "Send To Tuke Agency" button to submit for a FREE auto insurance quote. The Tuke Agency serves Upstate and Western New York. Final premium is subject to verification of information.

Name:
Street:
City:
State:
Zip Code:
E-Mail Address:
Telephone Number:
Current Carrier Information
Who is your current insurance carrier (not agency)?
Insurance carrier name:
What is the expiration date of your current automobile policy?
If you do not currently have insurance, enter length of lapse. (Enter "0" if you never had auto insurance.)
Vehicle Description
Vehicle #1 (Year, Make & Model)
Vehicle #1 (VIN #)
Vehicle #2 (Year, Make & Model)
Vehicle #2 (VIN #)
Vehicle #3 (Year, Make & Model)
Vehicle #3 (VIN #)
Vehicle Use
Vehicle #1
Vehicle #2
Vehicle #3
Driver Information
Driver #1
Driver Name
Date of Birth
Driver's License # (Required)
Driver #2
Driver Name
Date of Birth
Driver's License # (Required)
Coverages
Liability Coverage and Limits
NY No-Fault Limits
Uninsured/Underinsured Motorist coverages(s)
Comprehensive/Other Than Collision
Dedectible Vehicle #1
Dedectible Vehicle #2
Dedectible Vehicle #3

Collision
Vehicle #1
Vehicle #2
Vehicle #3
Towing Coverage
Rental Reimbursement Coverage
Please enter any questions or comments :