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Auto Insurance-NH.com
Auto Insurance-NH.com - Fast and Free New Hampshire Car Insurance Quotes

Auto Insurance-NH.com - Fast and Free NH automobile Insurance Quotes
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AN ONLINE SERVICE OF
IMMANUEL INSURANCE AGENCY, INC.
"Thanks for visiting our agency's website! Low rates, quality service, and top rated, insurance companies make our agency's car insurance plans unbeatable. Get a quote today!"

Immanuel Insurance Agency, Inc.
3 Brittany Lane
PO Box 300
Barrington, NH 03825

Phone: 603-335-4300
Toll Free: 800-464-5960
Fax: 603-822-7101
Email: david@immanuelins.com

  NH auto insurance quotes    

« Online Quick Quote »
On-Line New Hampshire Auto
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!

Accidents? Tickets? DUI's? NO PROBLEM! Our fast and friendly agents will shop top New Hampshire insurance companies to make sure your auto insurance is as cheap as possible!

CLICK HERE FOR QUOTE IF YOU HAVE MORE
THAN ONE VEHICLE OR DRIVER.


Your Personal Data

Your Name:
Street Address:
City:
State: (Must be New Hampshire)
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
 
OPT-OUT SELECTION: We realize your time is valuable. Rather than fill in all the underwriting information below, would it be easier to have us call you? If so, you can check the "Opt-Out" box above, press the send button at the bottom of this form, and have a friendly agent call you. If possible, please have your current policy handy as this has helpful information we may need.

If you want to continue the complete online quoting process, do NOT check the box and please continue below.


Primary Insured's Occupation:
Primary Insured's Company Sponsor, if any:
Primary Insured's Education Level:
 
Marital Status:
Single Married
Homeowner?
Yes No
 
Currently Insured?
(If yes, list carrier. If none, type No coverage)
 
What is Cost of Current Coverage
and Expiration Date?


DRIVER INFORMATION #1
Name: Birthdate:
Sex (M/F): # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 5 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Describe
Vehicle Use:
If Car is Driven to Work, List
One-Way Mileage Here:
Does Driver need
an SR22 FILING?
Yes No If YES to SR22 filing, why needed?
Give details on all violations or accidents:


VEHICLE #1 INFORMATION & COVERAGES
(if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
Year of vehicle: Make & Model:
 
Annual Mileage: Used in business?
(Explain):
 
Select Liability Limits
 
Select Comprehensive Deductible:
 
Select Collision Deductible:
 
Rental Car &
Towing Coverage?
YES NO
 
Are there residents in the household, ages 16 and over? (List Names & Ages in remarks below) YES NO
 
Comments or Remarks:
If More than 1 Vehicle or Driver, list Additional Vehicles (Year, Makes, and Models), and Drivers (Names, Ages, and Driving records):


Thank you for filling out this form COMPLETELY!
You'll be contacted ASAP!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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Auto Insurance-NH.com is a New Hampshire insurance agency with highly qualified professionals committed to finding the best coverages and prices for your Personal Auto Insurance needs.

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