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Personal Auto Insurance Quote Request

Auto insurance provides financial protection against physical damage and/or bodily injury resulting from traffic collisions and against liability that could also arise therefrom.

Due to the extreme restrictions and increasing premiums in the California Insurance Marketplace we are only writing insurance policies that have $300,000 in coverage for Bodily Injury, $300,000 in coverage for Property Damage or higher. We are not accepting clients who have tickets or accidents on their Motor Vehicle Report in the last 3-5 years including Not At Fault accidents. We do not write NonOwned Auto Policies or SR22 Policies.

In order for us to write a personal auto policy we are only working with clients who have expectations to have a fullly rounded insurance portfolio containing home, auto and life insurance with KS Pacific Insurance Agency.

Lastly, we need you to know that we will not provide insurance quotes until after we have received your prior insurance documents. There are no exceptions to this rule because it is required of us from the Insurance Companies we work with.

DRIVER #1

First name*

Last name*

Driver 1 Date of Birth*

Driver 1 License #*

Driver #1 Gender*

Driver 1 Marital Status*

DRIVER #2

If there is no Driver 2 then enter "NONE" in required fields

Driver 2 First Name*

Driver 2 Last Name*

Driver 2 DOB*

If no 2nd driver enter today's date

Month/Day/Year

Driver 2 License #*

If no 2nd driver enter None

Driver #2 Gender*

Driver 2 Relationship*

Location

Street address*

City*

Zip Code*

Email*

Phone number*

VEHICLE #1

CAR 1 YEAR*

CAR 1 MAKE*

CAR 1 MODEL*

CAR 1 VIN*

You can find the VIN# or vehicle identification number on the registration or inside the doorframe of the car.

HOW DO YOU USE THE VEHICLE*

VEHICLE #2

CAR 2 YEAR*

CAR 2 MAKE*

If no 2nd car enter None

CAR 2 MODEL*

If no 2nd car enter None

CAR 2 VIN*

You can find the VIN# or vehicle identification number on the registration or inside the doorframe of the car.

HOW DO YOU USE THE VEHICLE*

TICKETS AND ACCIDENTS IN THE LAST 3-5 YEARS*

Please list the dates and explain any tickets, violations or accidents in the last 5 years for all drivers. If there are none enter "none"

PRIOR INSURANCE DOCUMENTS UPLOAD*

In order for us to best serve our clients we require a copy of your curent insurance documents so that we can be sure we are matching your current coverage. Please upload those here.