Auto Quote Form

We have streamlined our application to make it easier for you to complete. This information will be used to quote your auto and not to be shared in anyway.

Name:
Address:
Address Line 2:
Phone Number:
E-Mail:
License Plate No.:
Drivers License No.:
Town Garaged:

Optional Bodily Injury:
Standard - $100,000/$300,000 Increased - $250,000/$500,000

Collision:
$500 Deductible$1000 Deductible

Comprehensive:
$500 Deductible$1000 Deductible

Substitute Transportation:
None$30/day$45/day

Towing:
None$50/per tow$100/per tow

Property Damage:
$100,000$250,000

Medical Payments
$5,000$10,000$25,000

I authorize Lehr & Barnes Insurance Agency, Inc. to use this information to provide me with a quote.

Disclaimer: It is our intent to release quote information only to you and we have taken every step to keep your information private. Lehr & Barnes Insurance Agency, Inc. does not accept any responsibility for information accidentally viewed by others via the Internet. Quotes are outlines of available coverage and are not binding in any legal matter. All quotes are subject to the terms conditions, provision, limitations and exclusions of the actual policy issued between the insurance company and yourself.