I need help with * NJPAIP-NJ Car Insurance Quote Other Than NJPAIP Car Insurance Rate quote NJ PAIP Rates are set by the State Dept of Insurance. You won't have to shop around. Select NJPAIP or Standard Policy QuoteHow Many NJ DMV/NJ Insurance Points do you have? * 1 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 togetherHave you been denied coverage recently? NA YES NO Effective Jan. 1ST 2009 Companies do not have to offer coverage to everyone.Is Your License SUSPENDED? NO YES Getting Restored If Suspended You will need A Licensed Driver.Any AT-Fault Accidents last 36 months * NO 1 2 3 4 5 6 7 8 9 10 At Fault accidents are 5 insurance points each.Phone #'s to reach you? *
(111) 111-1111 Multiple numbers are OK. Indicate day number please. Fax Number
Email Address? * Email where quote will be sent.Email Address Again * Verify Email address to send quote toLast Name? *
First Name? *
Vehicle Make|Model|Year #1 *
2008 Ford Mustang LS 4x4, se, dl, le & VIN Number etc. Vehicle Make|Model|Year #2
Leave blank if no other vehicles Your County? * 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 ResidenceTown Name/City? * Enter your NJ City of ResidenceMale or Female? * Male Female New Jersey Car Insurance Rates Are Gender BasedDate Of Birth * ex: 01/01/1961Marital Status * Single Married Divorced Widow/er Distance Driven- miles per day * 1 2 3 4 5 6 7 8 9 10 More than 10 One Way mileage to work or school.Liability Limits Requested * 15/30,000 25/50,000 50/100,000 100/300,000 250/500,000 0-NO Liability-BASIC ONLY 10,000 BASIC POLCY ONLY Leased Vehicles Require $100/300Property Damage Requested * $5,000 $10,000 $25,000 $50,000 $100,000 5,000 BASIC POLICY ONLY Leased Vehicles Require $50,000NJPIP Personal Injury Protection Requested * $250,000 $150,000 $75,000 $50,000 $15,000 15,000 BASIC POLICY ONLY NJPIP Covers Medical Expenses Accidents etc.Do you have Group Health Insurance? NO YES You May Be Eligble to Name NJ Group Health as Primary Saving MoneyPIP Personal Injury Protection deductible * $250 $500 $1000 $2,000 $2,500 Your out of pocket deductibleDoes Vehicle Have Airbags? * No Airbags Yes 1 Airbag Yes 2 or more Airbags Physical Damage Comprehensive * NO Liability Only Yes $500 deductible Yes $750 deductible Yes $1000 deductible Yes $1500 deductible Yes $2,000 deductible Full Coverage Comprehensive DeductibleCollision Coverage * NO Liability Only Yes $500 deductible Yes $750 deductible Yes $1000 deductible Yes $1500 deductible Yes $2,000 deductible Full Coverage Collision DeductibleStreet Address? * Zip? * Your State? * NJ New JerseyAre cars Leased/Financed/Paid Off? * 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? * Yes Registered to me No Registerd 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 Contact me right away This Week Next Week This Month Next Month Later Have you Had a DUI/DWI last 5 years? No Yes DUI-DWI is 9 Insurance PointsAdditional Information Other Drivers-Other Vehicles
List other drivers that need to be covered here Age M/F points vehicle driven etc. I consent to processing my quote request.