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New Quote: |
| Policy Effective Date |
Please enter the date you would like this policy to become
effective. The date cannot be in the past. The date cannot be more than 60
days in the future. |
| Residence State |
Please select the state within our territory
where you currently reside. |
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If you reside outside
our territory, please
click here for
other AAA clubs. |
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Applicant: |
| Applicant Full Legal Name |
Please enter the full legal name of the applicant(s). |
| Birth Date |
Please enter the birth date of the applicant(s). |
| Social Security Number |
Please enter the Social Security Number
of the applicant(s). Social Security Number is not required to complete a quote.
However, the Social Security Number will help ensure the accuracy of the information
obtained from consumer reporting agencies that is required to complete a quote. |
| Email Address |
Please enter the email address of the
first applicant. Email Address is not required to complete a quote. |
| Phone Number |
Please enter a phone number with area
code that the first applicant may be contacted. Phone Number is not required to
complete a quote. |
| Current Residence Address |
Please enter the household address where the applicants
currently reside. Please note, if the applicants have lived at this address for
less than 3 years, you will be required to enter a prior address on an upcoming
screen. |
| Years you have lived at this address |
Please select the length of time that most closely
reflects the years you have lived at the Current Residence Address. |
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Drivers: |
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For your convenience, the name and birth date for each applicant has
been prefilled as drivers. If you need to change the applicant driver’s name or date
of birth, please return to Applicant.
At least one driver must be completed.
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| Relationship to 1st Applicant |
The first applicant is identified as ‘Self’. For all other
drivers, please select the relationship of the driver to the 1st applicant listed
on the Applicant Info screen. Drivers may be related to first applicant as spouse,
child, parent, employee or other. |
| Name |
Please enter the full legal name of the driver. |
| Birth Date |
Please enter the birth date of the driver. |
| Gender |
Please select the gender of the driver. |
| Marital Status |
Please select the marital status of the driver. |
| Occupation |
Please select the occupation that most accurately
describes the driver's occupation. |
| Age first licensed in US |
Please enter the age at which the driver was first
licensed in the United States. |
| Current License Status |
Please select the current license status of the driver. |
| Does driver have liability insurance? |
Please select the most accurate response regarding
the prior liability insurance of the driver:
- Never been insured – driver has
never had auto liability insurance
- No Ins within past 12 months – driver had previously had auto liability insurance,
but this coverage has been lapsed or expired for more than twelve (12) months.
- Yes – driver currently maintains auto liability insurance
- No – driver has had auto liability insurance in the last 12 months, but this
coverage is currently lapsed or expired.
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| How long have you had continuous auto insurance? |
Please select the time period that most closely reflects
how long you have continuous auto insurance in the last 12 months:
- Under 6 months
- 6 months to under 12 months
- 12 months or more
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| Prior Lapses in last 12 months |
Please select the length of time that most closely reflects
how long you have not had auto insurance in the past 12 months. |
| Most Recent/Current Carrier |
Please select the insurance carrier of your most recent
or current auto insurance. |
| Years, Months with this carrier |
Please select the number of years you have been insured
with the Current Carrier identified above. If you have been insured with the Current
Carrier less than 1 year, select the number of months you have been insured with the
Current Carrier. |
| Policy Expiration Date |
Please enter the date that your current or most recent auto
policy will, or has, expired or lapsed. |
| Prior Bodily Injury Coverage Limit |
Please select the Bodily Injury that is closest to the
Bodily Injury limit of your most recent or current auto insurance policy. |
| Prior Rental Reimbursement |
Please select Yes or No to indicate if your most recent or
current auto insurance policy included rental reimbursement coverage. |
| Prior Address |
Please enter the prior household address where the driver
resided if they have lived at the Current Residence Address for less than three (3)
years. |
| Years at this residence |
Please select the length or time that most closely reflects
how long the driver has resided at the Prior Address. |
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When you have finished completing the driver details click
the Add/Update Driver button. |
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To cancel this driver, click the Cancel button. You
may still be required to delete the driver from the summary screen. |
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Drivers Summary: |
| Drivers Summary |
For your convenience, the name and birth date for each
applicant has been prefilled as drivers. If you need to change the applicant
driver’s name or date of birth, please return to Applicant.
At least one driver must be completed. For your convenience we have started
a driver for each applicant you listed on the previous screen. You must click the
EDIT link to the right of each of the drivers
shown to complete their details. |
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To remove a driver, click the
DELETE link to the right of the driver. |
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To add more drivers, click the Add Another Driver
button. |
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When you are finished completing the drivers, click the
Continue button. |
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Accidents & Violations: |
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Please enter all accidents and violations for each driver
that occurred within the last five years. |
| Driver Name |
Please select the name of the driver. |
| Date |
Please enter the date that the accident or violation
occurred. |
| Description |
Please select the description that most closely reflects
the accident or violation of the driver on the date. |
| Damage Amount |
Please enter the amount of the damage incurred in the
accident. Damage Amount is required for an accident. |
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When you have finished completing the accident/violation
details click the Add Accident/Violation button. |
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To edit the details of an accident/violation, click the
EDIT link to the right of the accident or
violation. |
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To remove an accident/violation, click the
DELETE link to the right of the accident or
violation. |
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Vehicle Details: |
| VIN |
Please enter the Vehicle Identification Number (VIN).
The VIN is not required to complete the quote. If you enter the VIN, the vehicle
year, make, model and default options will be automatically entered when you click
on ‘Retrieve VIN’. |
| Year |
Please select the vehicle model year, 1981 or newer.
If the vehicle model year is older than 1981, please contact an AAA licensed agent
for assistance. |
| Make |
Please select the vehicle make or manufacturer. |
| Model |
Please select the vehicle model. |
| Select Applicable Options |
Please select options that have been installed on the
vehicle by clicking in the appropriate checkbox. Based on either the VIN entered
or the Year/Make/Model selected, some of these options may be pre-selected for
you. |
| Date Purchased |
Please enter the date you purchased this vehicle. |
| Primary Vehicle Driver |
Please select the driver that most frequently operates
the vehicle. |
| Primary Vehicle Use |
Please select the option that best describes the
primary use of the vehicle. |
| Estimated Annual Mileage |
Please enter the estimated annual mileage for the vehicle.
Please enter full numbers in hundreds or thousands, e.g., 10000, not 10K. |
| Parked overnight at current household address |
Please select Yes or No to indicate if the vehicle is
parked overnight at the Current Residence Address. If the vehicle is not parked
at the Current Residence Address, you must enter the Vehicle Location Address and
select the Reason for this Location. |
| Vehicle Location Address |
Please enter the address (street, city, state, zip) of
the vehicle location is different from the Current Residence Address |
| Reason for this Location |
Please select the option that best describes the reason
the vehicle is not parked at the Current Residence Address. |
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When you have finished completing the vehicle details
click the Add/Update Vehicle button. |
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To cancel this vehicle, click the Cancel button.
You may still be required to delete the vehicle from the summary screen. |
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Vehicle Summary: |
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At least one vehicle must be completed. |
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To edit a vehicle, click the
EDIT link to the right of each of the vehicles. |
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To remove a vehicle, click the
DELETE link to the right of the vehicle. |
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To add more vehicles, click the Add Another
Vehicle button. |
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When you are finished completing the vehicle, click the
Continue button. |
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Incidental Drivers: |
| Incidental Drivers – Vehicle Assignment |
Please select a vehicle to assign any drivers that have
not been identified as a Primary Vehicle Driver. If you have more drivers than
vehicles, drivers not identified as a Primary Vehicle Driver must be identified
as an Incidental Driver on a vehicle. If you have only one vehicle, every driver
who is not the Primary Vehicle Driver, will be an incidental driver of the vehicle |
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Discounts: |
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Each driver may be eligible for certain driver discounts based
on their age, occupation, driving history, and vehicle assignment. The available discounts
will be listed below each driver's name. Please select Yes or No for each discount.
Note: Many discounts will require supporting documentation should you decide to
purchase this policy. |
| Auto/Home Discount |
If you insure your home/condo/apartment with AAA you may be
eligible for an auto/home discount of up to 10% on select coverages. Please select
whether you would like to see this quote with an Auto/Home Discount. |
| Defensive Driver/Accident Prevention Course Discount |
Qualified drivers may save as much as 10% off the premium for
certain coverages when they successfully complete an approved Motor Vehicle Accident
Prevention Course, National Safety Council Defensive Driving Course, or other similar
approved course. Amount of discount may vary by state. This discount is subject to
availability and certain restrictions may apply. |
| Driver Training Discount |
Save 10% off the premium for certain coverages when a
qualified rated driver successfully completes a driving school or high school driver
education course. This discount is subject to availability and certain restrictions
may apply. |
| Good Student Discount |
Save as much as 15% off the premium for certain coverages
when qualified drivers who are full time students attain specific scholastic
achievements. Amount of discount may vary by state. This discount is subject to
availability and certain restrictions may apply. |
| Student/Military Over 100 Miles Away From Home |
You may be eligible to receive a 10% discount on Bodily
Injury Liability and Property Damage Liability (BI & PD) and Collision coverages
if you have unmarried children under the age of 25 attending school more than 100
miles away from home or have joined the military and are stationed more than 100
miles away from home. |
| Military Personnel Discount (Louisiana only) |
Active Military Personnel based in Louisiana save 25% on
all automobile liability insurance policies. |
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Coverages: |
| The coverages listed are based on state and vehicle age.
Please select coverages that reflect your insurance needs. To compare our rates
accurately, please select the same coverages as your current or most recent policy.
You can find your current coverage limits on the policy declarations page of your
insurance policy. |
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