The Frigault Agency, Inc. Protecting all the things you love. Auto, Home, Life, Business, Boat.
 (315) 797-8080
136 Clinton Road (Rt 12b), New Hartford, NY, 13413
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Automobile Insurance Quote Request

This process will allow you to request a quote for up to 4 vehicles and 4 drivers.
Please remember that the more information provided, the more accurate the quote we provide will be. The fields marked in red are required.

This is some information you should have available to complete the form:

   1) Year/Make/Model or VIN for each vehicle
   2) Name/Date of Birth for each driver
   3) Accidents/Violations within the last 36 months

Note:  Items marked in red are required items and must be answered prior to clicking submit.

Referrered By:
Name: Phone:
Address: E-Mail:
City: State: SS#:
Spouse: Spouse SS#
Single/Married:Married  Single 
Children:
Yes  No   Driving: Yes No  Age(s):

Driver Information
     
Driver #1

 
DOB:
License#
Occupation: Education:
Defensive Driver TrainingYes No
 
Driver #2
DOB:
License#
Occupation: Education:
Defensive Driver TrainingYes No  
 
Driver #3  
DOB:
License#
Occupation: Education:
Defensive Driver TrainingYes No  
 
Driver #4      
DOB:
License#:
Occupation: Education:
Defensive Driver TrainingYes No    
 
Tickets in the last 39 months?  Yes No

DUI, DWI, or DWAI in the last 10 years?  Yes No

Prior 6 month insurance? Yes No    Company: 
Effective Dates:

Prior Bodily Injury Liability:

    
Vehicle Information
Vehicle #1
Year Make Model VIN#
Miles Driven To Work  Air Bag Yes No,  1 or 2
ABS:  YesNo DRL: YesNo Alarm:YesNo Type:
Antilock Braking SystemDaytime Running Lights 

     

Vehicle #2      
Year Make Model VIN#
Miles Driven To Work Air Bag Yes No, 1  or 2  
ABS: YesNo DRL:  YesNo Alarm:YesNo Type:
Antilock Braking SystemDaytime Running Lights 

     

Vehicle #3
Year Make Model VIN#
Miles Driven To Work Air Bag Yes No, 1  or 2
ABS:Yes No DRL: YesNo Alarm: YesNo Type:
Antilock Braking SystemDaytime Running Lights 

Vehicle #4
Year Make Model VIN#
Miles Driven To Work Air Bag Yes No, 1  or 2  
ABS:Yes No DRL: YesNo Alarm:  YesNo Type:
Antilock Braking SystemDaytime Running Lights 

Coverage Desired  

Policy Wide Coverages:

Bodily Injury Liability: Property Damage Liability:

SUM/UM: Personal Injury(PIP):

 

Vehicle Level Coverages:

Vehicle #1 Collision Deductible: Comprehensive Deductible:

Vehicle #2 Collision Deductible: Comprehensive Deductible:

Vehicle #3 Collision Deductible: Comprehensive Deductible:

Vehicle #4 Collision Deductible: Comprehensive Deductible:

 

Please ensure that all questions in red have been answered prior to clicking submit. 

                           
                                

 
We help you find the right solution by understanding your needs. Give us a call(315) 797-8080
136 Clinton Road (Rt 12b), New Hartford, NY, 13413