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Driver Information

First Name

M.I.

Last Name

Gender*

Male/Female

Male Female

Martial Status*

Martial Status

Single Married

Address

Apartment

Address Years

City

State

Zip Code

Home Phone

Mobile Phone

DOB

License #

License Years

Social

Spouse Information

Spouse Name

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Spouse SSN

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Vehicle Information

Year

Make

Model

Vin #

Coverage Requested

Coverage

Liability only Comprehensive & Collision

Prior Insurance

Insurance Company

Address

Phone

Policy #

Occupation

Occupation & Company

Address

Phone

Comments

Comments

Advanced Insurance & Tax
30-81 31 Street, Astoria NY 11102
Tel: 718-777-6661
Cell: 917-940-8901
[email protected]

INSURANCE SERVICES

All forms of insurance plans povided

AUTO

HOME

BUSINESS

Get the lowest rates from major companies!

Get started!

Basic Auto Quote Information

We will promptly email your auto insurance quote, after you fill out every field below and submit.

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