Automobile Insurance

Aquadro Insurance will analyze your motor vehicle needs and determine which coverages best suit your personal needs. We then insure that you receive all the credits and discounts to which you are entitled. In addition to coverage for your personal automobile, we provide coverage for commercial vehicles, recreational vehicles, motorcycles and antique cars.

For a quote, please complete the form below or call our office for a personal consultation.

Name
(First, Middle, Last):
Address:
City: State: Zip:
Phone: Work #: Ext: Home #:
Email: Fax #:
Best Time to Reach: Morning Afternoon Evening
Best Way to Reach: Phone Fax Email

Driver Information

Please list all licensed household members.
Name Date of Birth
(Required)		 License # State No. of Yrs.
Driving
1.
2.
3.
4.

Vehicle Information

Vehicle #1 Vehicle #2 Vehicle #3
Year
Make
Model/TYPE
Estimated
Annual Mileage

 If Antique Auto, Please State Value: $

 If Motorcycle, Please State CC's: Value: $

Anti-Theft Devices

Vehicle #1 Vehicle #2 Vehicle #3
Alarm Yes No Yes No Yes No
Etched
Windows		 Yes No Yes No Yes No
Lojack Yes No Yes No Yes No

Liability Coverage

The coverage limits shown in the boxes below are our Minimum recommendations for coverage for you and your family. To choose other available coverage options, please click on the drop-down boxes.

Vehicle #1 Vehicle #2 Vehicle #3
Uninsured
Motorist
per person/per accident
per person/per accident
per person/per accident
Property
Damage

Optional
Bodily Injury
to Others
per person/per accident
per person/per accident
per person/per accident
Medical
Payments

Underinsured
per person/per accident
per person/per accident
per person/per accident

Collision Coverage

The coverage limits in the boxes below are our recommendations for coverage. To choose other available options, please click on the drop-down boxes.

Vehicle #1 Vehicle #2 Vehicle #3
Collision

Comprehensive

Substitute
Transportation

Towing & Labor


Additional Comments:
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    Aquadro & Associates Insurance Agency Inc ~ 355 Bridge Street ~ P.O. Box 357 ~ Northampton, MA 01061 ~ 413-586-7373 ~ 1-800-878-7374