Auto Insurance

Important Notice
As part of the insurance quotation process, each insurance carrier will order credit, motor vehicle and prior loss reports. This information will be used to evaluate your application.  Your return of this form authorizes Shewchuck Insurance Agency to initiate insurance quotations that will prompt the order of consumer reports by the insurance carrier on behalf of yourself and your spouse, other individuals, or registered domestic partner or civil union partner as defined by the laws in the state in which a policy is quoted and/or may be issued.

The following form is a good starting point for quoting your auto insurance. Please be as complete and accurate as possible. We may call you if we need more information. Thank you.

    Current Coverage Information


    YesNo

    Vehicle Description


    PleasureCommuteBusiness


    PleasureCommuteBusiness


    PleasureCommuteBusiness


    PleasureCommuteBusiness

    Coverage

    Driver Information


    MaleFemale


    MaleFemale


    MaleFemale


    MaleFemale

    Accidents and Violations


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo

    Driver Discounts


    Driver 1Driver 2Driver 3Driver 4


    Driver 1Driver 2Driver 3Driver 4


    Driver 1Driver 2Driver 3Driver 4

    Additional Information


    YesNo


    YesNo

    © 2024 SHEWCHUCK INSURANCE AGENCY, INC.

    This website provides only a general description of Shewchuck Insurance Agency and is not a statement of contract. Not all features or discounts described on this website are available in every state or from every carrier and total savings and premiums may vary. We offer coverage from selected standard market carriers.