I need help with *
NJPAIP-NJ Car Insurance Rate quote
NJ PAIP Rates are set by the State Dept of Insurance. You
wont have to shop around.
How Many Points DMV/Insurance Points added together?
*
Select Points Total
1
0
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
more than 30
MVC/DMV and or Insurance points added together
Have you been denied coverage recently?
Select One
YES
NO
Effective Jan. 1ST 2009 Companies do not have to offer coverage to everyone.
Is Your License SUSPENDED?
Select One
NO
YES
Getting Restored
If Suspended You will need A Licensed Driver.
Any AT-Fault Accidents last 36 months
*
Select One
NO
1
2
3
4
5
6
7
8
9
10
At Fault accidents 5 points each.
Phone #'s to reach you? *
Example 8569082015 Multiple Numbers O.K. Day Number/s Are Best. Indicate day number please.
Email Address/s? *
Email Address Again *
Last Name? *
First Name? *
Vehicle Make|Model|Year #1 *
2005 Ford Mustang LS give as much information as possible. 4x4, se,
dl, le etc.
Vehicle Make|Model|Year #2
Leave blank if no
other vehicles
Your County? *
Select One
Atlantic County
Bergen County
Burlington County
Camden County
Cape May County
Cumberland County
Essex County
Gloucester County
Hudson County
Hunterdon County
Mercer County
Middlesex County
Monmouth County
Morris County
Ocean County
Passaic County
Salem County
Somerset County
Sussex County
Union County
Warren County
Enter your NJ County of Residence
Town Name/City? *
Male or Female? *
Select One
Male
Female
New Jersey Car Insurance Rates Are Gender Based
Date Of Birth *
Marital Status *
Select One
Single
Married
Divorced
Widow/er
Distance Driven- miles per day *
Select One
1
2
3
4
5
6
7
8
9
10
More than 10
One Way mileage to work or school.
Liability Limits Requested *
Select One
15/30,000
25/50,000
50/100,000
100/300,000
250/500,000
Leased Vehicles Require $100/300
Property Damage Requested *
Select One
$5,000
$10,000
$25,000
$50,000
$100,000
Leased Vehicles Require $50,000
NJPIP Personal Injury Protection Requested
*
Select One
$250,000
$150,000
$75,000
$50,000
$15,000
NJPIP Covers Medical Expenses Accidents etc.
Do you have Group Health Insurance?
NO
YES
You May Be Eligible to Name NJ Group Health as Primary Saving Money
PIP Personal Injury Protection deductible
*
Select One
$250
$500
$1000
$2,000
$2,500
Your out of pocket deductible
Airbags? *
No Airbags
Yes 1 Airbag
Yes 2 or more Airbags
Physical Damage Comprehensive *
Select One
NO Liability Only
Yes $500 deductible
Yes $750 deductible
Yes $1000 deductible
Yes $1500 deductible
Yes $2,000 deductible
Comprehensive Deductible
Collision Coverage *
Select One
NO Liability Only
Yes $500 deductible
Yes $750 deductible
Yes $1000 deductible
Yes $1500 deductible
Yes $2,000 deductible
Collision Deductible
Street Address? *
Zip? *
Your State? *
NJ
New Jersey
Are cars Leased/Financed/Paid Off? *
Select One
Financed
Leased
Paid Off
Leased Vehicles Require 100/300/50,000 If leased
you will need a copy of the lease.
Is vehicle Registered to you? *
Select One
Yes Registered to me
No registered to someone else
Registered to Lease Company
Title is OK, Registration Expired Ok,
How many licensed drivers in house: TOTAL #
*
1
2
3
4
5
6
7
8
9
10
You will need a copy of each NJ DL & Insurance
Information.
When do you Need Coverage?
ASAP
This Week
Next Week
This Month
Next Month
Later
Have you Had a DUI/DWI last 5 years?
Select One
No
Yes
DUI-DWI is 9 Insurance Points
Additional Information Other Drivers-Other Vehicles
Please list other drivers that need to be covered
here Age M/F points vehicle driven etc. I consent to processing my quote request.
Your Quote will be emailed.
You may need to check Bulk Email folder
to find your quote
NJ PAIP NJ Car Insurance Quote Form. Your
Quote will be emailed directly to you.
