A.I.A. Insurance Agents, Inc.
A.I.A. Insurance Agents, Inc.
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Phone
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An Independent Insurance Agency: Insuring Your Future
A.I.A. Insurance Agents, Inc.
A.I.A. Insurance Agents, Inc.
A.I.A. Insurance Agents, Inc.
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A.I.A. Insurance Agents, Inc.
A.I.A. Insurance Agents, Inc.

Get A Quote

Automobile Insurance Quote

We would like to provide you with a free, no-obligation automobile insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Personal Information
Name:
Address:
City:   State:   Zip:
Day Phone:   Night Phone:
Best Time To Call:   AM   PM
Email Address:

Current Auto Insurance Information
Company Name (not agency):
Policy Expiration Date:   Premium Amount: $
Term: 6 Months   1 Year   Other:

Vehicle Information
(include all cars you or your family members own or lease)
Car
#1
Year
Make
Model
Body Type
Vehicle ID# (VIN)
Name of Title Holder
Annual Milage
Drive to school/work?
# of miles
(one way)
  Airbags  
Car Alarm
Y N
Y N
Y N
If vehicle is kept at an address other than that listed above, please indicate below
Location City:   State:   Zip:

Car
#2
Year
Make
Model
Body Type
Vehicle ID# (VIN)
Name of Title Holder
Annual Milage
Drive to school/work?
# of miles
(one way)
  Airbags  
Car Alarm
Y N
Y N
Y N
If vehicle is kept at an address other than that listed above, please indicate below
Location City:   State:   Zip:

Car
#3
Year
Make
Model
Body Type
Vehicle ID# (VIN)
Name of Title Holder
Annual Milage
Drive to school/work?
# of miles
(one way)
  Airbags  
Car Alarm
Y N
Y N
Y N
If vehicle is kept at an address other than that listed above, please indicate below
Location City:   State:   Zip:

Car
#4
Year
Make
Model
Body Type
Vehicle ID# (VIN)
Name of Title Holder
Annual Milage
Drive to school/work?
# of miles
(one way)
  Airbags  
Car Alarm
Y N
Y N
Y N
If vehicle is kept at an address other than that listed above, please indicate below
Location City:   State:   Zip:

Liability Limit For ALL Cars
Choose either   Bodily Injury   and   Property Damage
or   Single Limit
Bodily Injury
        
Property Damage
Single Limit

Deductibles and Misc.
Car#
Comprehensive Deductible
Collision Deductible
Towing
Loss of Use
1
Yes
Yes
2
Yes
Yes
3
Yes
Yes
4
Yes
Yes

Driver Information
(include all licensed drivers in your household)
Driver
#1
Driver's Name
Drivers License Information
DL#: State: Yr's Licensed:
Relation
Date of Birth
Sex
Marital Status
Courses Completed Last 3 yrs
M
F
Married  Single
Drivers Ed: 
Accident Prevention: 

Driver
#2
Driver's Name
Drivers License Information
DL#: State: Yr's Licensed:
Relation
Date of Birth
Sex
Marital Status
Courses Completed Last 3 yrs
M
F
Married  Single
Drivers Ed: 
Accident Prevention: 

Driver
#3
Driver's Name
Drivers License Information
DL#: State: Yr's Licensed:
Relation
Date of Birth
Sex
Marital Status
Courses Completed Last 3 yrs
M
F
Married  Single
Drivers Ed: 
Accident Prevention: 

Driver
#4
Driver's Name
Drivers License Information
DL#: State: Yr's Licensed:
Relation
Date of Birth
Sex
Marital Status
Courses Completed Last 3 yrs
M
F
Married  Single
Drivers Ed: 
Accident Prevention: 

Driver History
List ANY convictions for ANY driver convicted of moving traffic violations in the past 3 years
Driver
Date
Type of Conviction
Fines
Speed Over Limit
$
mph
$
mph
$
mph
$
mph

List ANY driver who has had license suspensions, revocations or DUI convictions below
Driver
License Suspended or Revoked
DUI Conviction For:
Suspended   Revoked  
Alcohol   Drugs  
Suspended   Revoked  
Alcohol   Drugs  
Suspended   Revoked  
Alcohol   Drugs  
Suspended   Revoked  
Alcohol   Drugs  

List ANY driver involved in accidents, regardless of fault, in the past 5 years
Driver
Date
Description
Cost
Fines
Injuries
At Fault
$
$
Yes
Yes
$
$
Yes
Yes
$
$
Yes
Yes
$
$
Yes
Yes

Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have
additional information where there was not enough fields above, please enter them here.

Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

   


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A.I.A. Insurance Agents, Inc.
A.I.A. Insurance Agents, Inc.
A.I.A. Insurance Agents, Inc.
A.I.A. Insurance Agents, Inc.
1038 Foothill Blvd.
La Canada Flintridge, CA 91011
Phone: 818-790-1158
Fax: 818-790-5815
aia@aiainsurance.net

CA License #: 0555067

A.I.A. Insurance Agents, Inc.
A.I.A. Insurance Agents, Inc.
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A.I.A. Insurance Agents, Inc.
Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.
 
A.I.A. Insurance Agents, Inc.

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Privacy Notice: Your privacy while visiting our website is important to us. Because there are parts of our site where we ask you to provide us with certain types of personal information about yourself, we want you to know how we will use it. We will use the information that you give us explicitly for the purposes stated on any online electronic form on this website, which in most cases will be for quoting, service, and information requests. We will not sell, share, or turn over any information you provide to any other person or organization. We may make it part of a reference source for future contact with you by our organization. We take your privacy very seriously, and ask that you contact us directly if you have any questions or concerns about the use of our website.
A.I.A. Insurance Agents, Inc.