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Automobile Quote - Up to 4 Drivers and 2 Vehicles

The quotes provided here are for Massachusetts only.
Fill out the form below to obtain a Massachusetts auto quote. All red fields are required. Be careful to include their information before submitting your form. You may add up to 4 drivers and 2 vehicles on this quote form. For additional vehicles or drivers, feel free to call us. For a quick quote on just 1 vehicle and 1 driver, see our Quick Quote form. For state of Massachusetts explanations of the coverages down in the "Insurance Coverages" section, click the "?" button next to the coverage. These help links connect you with the Massachusetts Division of Insurance website explanations of the various insurance coverages.
The quotes provided here are for Massachusetts only.
Vehicle(s) Registration Information Section The name and address to which the vehicle(s) is or will be registered:
Name:
Street:
City/State/Zip:	/ /
Home Phone:	Work Phone:
Email Address:
Driver Information Section Review Sections:
State Licensed:	Driver 1
	Driver 2
	Driver 3
	Driver 4
Years of Driving Experience:	Driver 1
	Driver 2
	Driver 3
	Driver 4
If less than 3 years, have you completed a course in Driver Training?	Driver 1
	Driver 2
	Driver 3
	Driver 4
Drivers License Number:	Driver 1
	Driver 2
	Driver 3
	Driver 4
Date of Birth	Driver 1
	Driver 2
	Driver 3
	Driver 4
Please check what applies to the driver:	Driver 1	Over the age of 65 Purchased a monthly transit pass (at least 11 months)
	Driver 2	Over the age of 65 Purchased a monthly transit pass (at least 11 months)
	Driver 3	Over the age of 65 Purchased a monthly transit pass (at least 11 months)
	Driver 4	Over the age of 65 Purchased a monthly transit pass (at least 11 months)
Has driver had any at-fault accidents or moving violations in the past six (6) years?	Driver 1
	Driver 2
	Driver 3
	Driver 4
If yes, please give a brief description:	Driver 1
	Driver 2
	Driver 3
	Driver 4

Vehicle Information Section Review Sections:
Year	Vehicle 1
Year	Vehicle 2
Make	Vehicle 1
Make	Vehicle 2
Model (Please be as specific as possible. ie. Honda Accord LX, 4 door)	Vehicle 1
	Vehicle 2
City Primarily Garaged:	Vehicle 1
City Primarily Garaged:	Vehicle 2
Please check all that apply to this vehicle.
Airbags	Vehicle 1
Airbags	Vehicle 2
Automatic Seatbelts	Vehicle 1
Automatic Seatbelts	Vehicle 2
Drive less than 5,000 miles per year	Vehicle 1
Drive less than 5,000 miles per year	Vehicle 2
Drive between 5,000 miles and 7,500 miles per year	Vehicle 1
Drive between 5,000 miles and 7,500 miles per year	Vehicle 2
Antitheft device (Alarm)	Vehicle 1
Antitheft device (Alarm)	Vehicle 2
Vehicle Recovery System (LoJack)	Vehicle 1
Vehicle Recovery System (LoJack)	Vehicle 2

Insurance Coverages Section Review Sections:
Compulsory Insurance (Mandatory)
	1. Bodily Injury to Others:	Vehicle 1	$20,000 per person / $40,000 per accident
		Vehicle 2	$20,000 per person / $40,000 per accident
	2. Personal Injury Protection:	Vehicle 1	$8,000 per person
		Vehicle 2	$8,000 per person
	3. Bodily Injury caused by uninsured auto:	Vehicle 1
		Vehicle 2
	4. Damage to someone else's property:	Vehicle 1
		Vehicle 2
Optional Insurance
	5. Optional Bodily Injury To Others:	Vehicle 1
		Vehicle 2
	6. Medical Payments:	Vehicle 1
		Vehicle 2
	7. Collision Coverage/ Deductible:	Vehicle 1
		Vehicle 2
	8. Limited Collision:	Vehicle 1
		Vehicle 2
	9. Comprehen-sive Coverage:	Vehicle 1
		Vehicle 2
	10. Substitute Transportation:	Vehicle 1
		Vehicle 2
	11. Towing and Labor:	Vehicle 1
		Vehicle 2
	12. Bodily In-jury caused by underinsured:	Vehicle 1
		Vehicle 2
End of Form Review Sections: Select Response Method, then click the Submit button below
Response Method
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Fax Number:
Mailing Address:		Street:
		City/State/Zip:	/ /

How did you hear of us? Other:

Comments:

We will send your quote promptly.
Thank you for considering Corkin Insurance!