California Insurance

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Fill out the car/auto insurance quote Form please.If more that 2 cars please use comments sections.

Personal Information
Full Name*
1st Driver 2nd Driver
Address*
1st Driver 2nd Driver
Zip Code*
1st Driver 2nd Driver
Home phone*
1st Driver 2nd Driver
Cell phone*
1st Driver 2nd Driver
Email*
1st Driver 2nd Driver
Gender*
1st Driver 2nd Driver
Date of Birth*
1st Driver 2nd Driver
Status*
1st Driver 2nd Driver
Do you have insurance in your vehicle?*
1st Driver 2nd Driver
If yes, what company?*
1st Driver 2nd Driver
List all citations & accidents in the past 3 years*
1st Driver 2nd Driver
Vehicle Information
Year & maker*
1st Driver 2nd Driver
Model*
1st Driver 2nd Driver
Body style*
1st Driver 2nd Driver
2 doors | 4 doors | Convertible | Station Wagon | Pick Up | Van
Vehicle primarily used*
1st Driver 2nd Driver
Personal | Business | Artisan
Miles yearly*
1st Driver 2nd Driver
Personal | Business | Artisan
Coverage and limits
Liability Limits*
1st Driver 2nd Driver
N/A | State Minimum | 15/30/10 | 50/100/25 | 100/300/50
Un(der)insured Motorist Will Match Liability Selection*
1st Driver 2nd Driver
Medical/Personal Injury Protection - Will Match Liability Selection*
1st Driver 2nd Driver
Comp & collision
COMP / Collision Deductible*
1st Driver 2nd Driver
Towing*
1st Driver 2nd Driver
Rental reimbursement*
1st Driver 2nd Driver
Comments

License: OG 05720

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Phone:
323-264-3226

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105 S. Rowan Ave. Suite 105
Los Angeles, CA 90063

Email:
quotes@leninsurance.com

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105 S. Rowan Ave. Suite 105
Los Angeles, CA 90063