Personal Auto Quote Purmort & Martin Insurance - Local Agents Working for You ; Insurance Quotes from Someone You Can Trust Click Here or Call (941) 366-7070 Step 1 of 16 6% Please provide the following information and we will take care of your request within 24 business hours. Please remember to never assume that changes have been made to your insurance until you have received confirmation from our office. All personal information is kept strictly confidential and will only be used in the process of providing an insurance quote. Personal InformationWhat is your name:*S.S.N. (Optional):In many cases, this is required for an accurate quote.How did you hear about us:*ReferralSearch EngineAdvertisingYellow PagesOther Contact InformationPhone Number:*Email address:* What is the best way to contact you:*EmailPhoneIf by phone, when is the best time to contact you:*MorningAfternoonEveningWeekends Current Insurance Information We may be able to find premium discounts based on the following: claim free, combine auto and home policies, multiple autos, good student, non-smoker and passive restraints.What is your current premium (optional):Current insurance company:*Current policy expiration date:* MM DD YYYY How long have you been with your current insurance company:*1 year2 years3+ yearsNot currently insuredNo prior insuranceWhy are you thinking about changing: Price Service Claims Other Please select one or more of the above choices. Claims HistoryHave there been any claims filed in the past 5 years: Auto Homeowners Other Please select one or more of the above choices. Protection for YouWhat is your comprehensive deductible:*select...None$100 Deductible$250 Deductible$500 Deductible$1,000 DeductibleWhat is Comprehensive Coverage Some of the coverages provided under comprehensive include theft, glass breakage, fire, windstorm, hail, water, falling objects, vandalism, explosion, or hitting a bird or animal. You may consider higher deductibles to lower your premiums.What is your collision deductible:*None$100 Deductible$250 Deductible$500 Deductible$1,000 DeductibleWhat is Collision Coverage Collision covers damage to your car when your car hits, or is hit by, another vehicle, or other object. It pays to fix your vehicle less the deductible you choose. To keep your premiums low, select as large a deductible as you feel comfortable paying out of pocket.Do you have towing coverage:*YesNoShould I have a Towing Coverage When you have this coverage the insurer will pay reasonable expenses incurred for towing your car to the nearest place where necessary repairs can be made during regular business hours, towing your car out if it is stuck on or next to a public street or highway,etc.Do you have rental car coverage:*YesNoDo I need Coverage for Rental Cars Rental Reimbursement coverage provides a specified amount for you to rent a vehicle while your covered auto is being repaired or replaced after a loss covered under Comprehensive or Collision.What are your current medical payment limits:*None$500$1,000$5,000How are Medical Payments Handled Medical Payments coverage provides coverage for necessary and reasonable medical and funeral expenses incurred as the result of an automobile accident.What are your current uninsured/underinsured motorists limits:*No Coverage$25,000 person/$50,000 accident/$25,000 property$50,000 person/$100,000 accident/$50,000 property$50,000 person/$300,000 accident/$50,000 property$100,000 person/$300,000 accident/$100,000 propertyWhat happens if the other person doesn't have Insurance? Uninsured/underinsured Motorist coverage pays for bodily injury to you or your passengers involving a driver who has little or no liability coverage. Protection for other PeopleWhat are your current bodily injury & property damage damage limits:*$25,000 person/$50,000 accident/$25,000$50,000 person/$100,000 accident/$50,000$100,000 person/$300,000 accident/$50,000$100,000 person/$300,000 accident/$100,000$250,000 person/$500,000 accident/$100,000 propertyWhat do I want my Policy to pay This pays for bodily injury or property damage for which you become legally responsible due to an auto accident. For example, you were in an accident that was your fault and there was more than say $300,000 in damages, what is the amount you would want your policy to pay?What are your current personal injury protection (PIP) payment limits:*None$2,500$5,000$10,000What is Personal Injury Protection? PIP may cover the medical, hospital and funeral expenses of the named insured, others in his vehicles and pedestrians struck by him. Driver InformationDriver # 1 name:*Driver # 1 Social Security Number (Optional):Driver # 1 license number (Optional):Driver # 1 age was this driver first licensed:*Driver # 1 date of birth:* MM DD YYYY Driver # 1 occupation:*select...Administrative/ClericalArchitectBusiness OwnerCertified Public AccountantClergyConstruction TradesDentistDisabledEngineerHomemakerDriver # 1 relationship:*select...SelfSpouseSonDaughterDriver # 1 highest level of education this driver has completed:*select...Some or no high schoolHigh School DiplomaGEDSome CollegeAssociates DegreeBachelors DegreeDoctorate DegreeOther Professional DegreeTrade/Vocational SchoolDriver # 1 current U.S. state license status:*select...Suspended LicenseNo Valid LicenseAKALARAZCACOCTDCDEFLGAHIIAILINIDKSKYLAMAMDMEMINMMOMSMTNCNDNENHNJNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYDriver # 1 gender:*select...MaleFemaleDriver # 1 marital status:select...MarriedSingleOtherDriver # 1 completed approved defensive driving course:*select...YesNoDriver # 1 past 5 years has license been suspended or revoked:*NoYesDriver # 1 full-time student:*NoYesDriver # 1 require an SR-22 or Financial Responsibility Statement:*YesNoDriver # 1 had any accidents in the past 5 years:*YesNoIs there another driver?*YesNo Complete Information for Driver 2Driver # 2 name:*Driver # 2 Social Security Number (Optional):Driver # 2 license number (Optional):Driver # 2 age was this driver first licensed:*Driver # 2 date of birth:* MM DD YYYY Driver # 2 occupation:*select...Administrative/ClericalArchitectBusiness OwnerCertified Public AccountantClergyConstruction TradesDentistDisabledEngineerHomemakerDriver # 2 relationship:*select...SelfSpouseSonDaughterDriver # 2 highest level of education this driver has completed:*select...Some or no high schoolHigh School DiplomaGEDSome CollegeAssociates DegreeBachelors DegreeDoctorate DegreeOther Professional DegreeTrade/Vocational SchoolDriver # 2 current U.S. state license status:*select...Suspended LicenseNo Valid LicenseAKALARAZCACOCTDCDEFLGAHIIAILINIDKSKYLAMAMDMEMINMMOMSMTNCNDNENHNJNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYDriver # 2 gender:*select...MaleFemaleDriver # 2 marital status:*select...MarriedSingleOtherDriver # 2 completed approved defensive driving course:*select...YesNoDriver # 2 past 5 years has license been suspended or revoked:*NoYesDriver # 2 full-time student:*NoYesDriver # 2 require an SR-22 or Financial Responsibility Statement:*YesNoDriver # 2 had any accidents in the past 5 years:*YesNoIs there another driver other than 1 and 2?*YesNo Complete Information for Driver 3Driver # 3 name:*Driver # 3 Social Security Number (Optional):Driver # 3 license number (Optional):Driver # 3 age was this driver first licensed:*Driver # 3 date of birth:* MM DD YYYY Driver # 3 occupation:*select...Administrative/ClericalArchitectBusiness OwnerCertified Public AccountantClergyConstruction TradesDentistDisabledEngineerHomemakerDriver # 3 relationship:*select...SelfSpouseSonDaughterDriver # 3 highest level of education this driver has completed:*select...Some or no high schoolHigh School DiplomaGEDSome CollegeAssociates DegreeBachelors DegreeDoctorate DegreeOther Professional DegreeTrade/Vocational SchoolDriver # 3 current U.S. state license status:*select...Suspended LicenseNo Valid LicenseAKALARAZCACOCTDCDEFLGAHIIAILINIDKSKYLAMAMDMEMINMMOMSMTNCNDNENHNJNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYDriver # 3 gender:*select...MaleFemaleDriver # 3 marital status:*select...MarriedSingleOtherDriver # 3 completed approved defensive driving course:*select...YesNoDriver # 3 past 5 years has license been suspended or revoked:*NoYesDriver # 3 full-time student:*NoYesDriver # 3 require an SR-22 or Financial Responsibility Statement:*YesNoDriver # 3 had any accidents in the past 5 years:*YesNoIs there another driver other than 1, 2, and 3?*YesNo Complete Information for Driver 4Driver # 4 name:*Driver # 4 Social Security Number (Optional):Driver # 4 license number (Optional):Driver # 4 age was this driver first licensed:*Driver # 4 date of birth:* MM DD YYYY Driver # 4 occupation:*select...Administrative/ClericalArchitectBusiness OwnerCertified Public AccountantClergyConstruction TradesDentistDisabledEngineerHomemakerDriver # 4 relationship:*select...SelfSpouseSonDaughterDriver # 4 highest level of education this driver has completed:*select...Some or no high schoolHigh School DiplomaGEDSome CollegeAssociates DegreeBachelors DegreeDoctorate DegreeOther Professional DegreeTrade/Vocational SchoolDriver # 4 current U.S. state license status:*select...Suspended LicenseNo Valid LicenseAKALARAZCACOCTDCDEFLGAHIIAILINIDKSKYLAMAMDMEMINMMOMSMTNCNDNENHNJNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYDriver # 4 gender:*select...MaleFemaleDriver # 4 marital status:*select...MarriedSingeOtherDriver # 4 completed approved defensive driving course:*select...YesNoDriver # 4 past 5 years has license been suspended or revoked:*NoYesDriver # 4 full-time student:*NoYesDriver # 4 require an SR-22 or Financial Responsibility Statement:*YesNoDriver # 4 had any accidents in the past 5 years:*YesNo Vehicle InformationVehicle # 1 year:*select...200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980Vehicle # 1 make:*select...AcuraAudiBMWBuickCadillacChevroletChryslerDaewooDodgeFordGMCHondaHyundaiInfinitiIsuzuJaguarJeepKiaLand RoverLexusLincolnMazdaMercedes BenzMercuryMiniMitsubishiNissanOldsmobilePontiacPorscheSaabSaturnSabaruSuzukiToyotaVolkswagonVolvoTypeVehicle # 1 model:*Vehicle # 1 Vehicle Identification Number (VIN):*Vehicle # 1 annual mileage:*Vehicle # 1 distance (one way) to work or school:*Vehicle # 1 original vehicle cost:*Vehicle # 1 kept at home address:*YesNoVehicle # 1 days driven to work or school:*select...1234567Vehicle # 1 ownership:*select...Paid forMaking PaymentsLeasedVehicle # 1 type of anti-theft device:*select...1) None2) VIN etching and ignition or starter cut off switch3) Number 2 plus at least two of the following: glass sensor, vibration sensor, motion sensor or ultronic sensor4) Number 3 plus a hood lock/latch and backup battery5) Number 4 plus an active alarm6) Number 5 plus a vehicle recovery device7) OtherVehicle # 1 primary use:*select...To/from workJust for pleasureSchoolBusiness callsDeliveryFarm or ranchClergymanArtisanfedGovernment/otherVehicle # 1 registration:*select...Applicant onlySpouse onlyApplicant and spouseApplicant and/or spouse and child under the age of 23Leasing companyOtherStill has another vehicle?*YesNo Vehicle # 2 year:*select...200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980Vehicle # 2 make:*select...AcuraAudiBMWBuickCadillacChevroletChryslerDaewooDodgeFordGMCHondaHyundaiInfinitiIsuzuJaguarJeepKiaLand RoverLexusLincolnMazdaMercedes BenzMercuryMiniMitsubishiNissanOldsmobilePontiacPorscheSaabSaturnSabaruSuzukiToyotaVolkswagonVolvoTypeVehicle # 2 model:*Vehicle # 2 Vehicle Identification Number (VIN):*Vehicle # 2 annual mileage:*Vehicle # 2 distance (one way) to work or school:*Vehicle # 2 original vehicle cost:*Vehicle # 2 kept at home address:*YesNoVehicle # 2 days driven to work or school:*select...1234567Vehicle # 2 ownership:*select...Paid forMaking PaymentsLeasedVehicle # 2 type of anti-theft device:*select...1) None2) VIN etching and ignition or starter cut off switch3) Number 2 plus at least two of the following: glass sensor, vibration sensor, motion sensor or ultronic sensor4) Number 3 plus a hood lock/latch and backup battery5) Number 4 plus an active alarm6) Number 5 plus a vehicle recovery device7) OtherVehicle # 2 primary use:*select...To/from workJust for pleasureSchoolBusiness callsDeliveryFarm or ranchClergymanArtisanfedGovernment/otherVehicle # 2 registration:*select...Applicant onlySpouse onlyApplicant and spouseApplicant and/or spouse and child under the age of 23Leasing companyOtherStill has another vehicle other than 1 and 2?*YesNo Vehicle # 3 year:*select...200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980Vehicle # 3 make:*select...AcuraAudiBMWBuickCadillacChevroletChryslerDaewooDodgeFordGMCHondaHyundaiInfinitiIsuzuJaguarJeepKiaLand RoverLexusLincolnMazdaMercedes BenzMercuryMiniMitsubishiNissanOldsmobilePontiacPorscheSaabSaturnSabaruSuzukiToyotaVolkswagonVolvoTypeVehicle # 3 model:*Vehicle # 3 Vehicle Identification Number (VIN):*Vehicle # 3 annual mileage:*Vehicle # 3 distance (one way) to work or school:*Vehicle # 3 original vehicle cost:*Vehicle # 3 kept at home address:*YesNoVehicle # 3 days driven to work or school:*select...1234567Vehicle # 3 ownership:*select...Paid forMaking PaymentsLeasedVehicle # 3 type of anti-theft device:*select...1) None2) VIN etching and ignition or starter cut off switch3) Number 2 plus at least two of the following: glass sensor, vibration sensor, motion sensor or ultronic sensor4) Number 3 plus a hood lock/latch and backup battery5) Number 4 plus an active alarm6) Number 5 plus a vehicle recovery device7) OtherVehicle # 3 primary use:*select...To/from workJust for pleasureSchoolBusiness callsDeliveryFarm or ranchClergymanArtisanfedGovernment/otherVehicle # 3 registration:*select...Applicant onlySpouse onlyApplicant and spouseApplicant and/or spouse and child under the age of 23Leasing companyOtherStill has another vehicle other than 1, 2, and 3?*YesNo Vehicle # 4 year:*select...200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980Vehicle # 4 make:*select...AcuraAudiBMWBuickCadillacChevroletChryslerDaewooDodgeFordGMCHondaHyundaiInfinitiIsuzuJaguarJeepKiaLand RoverLexusLincolnMazdaMercedes BenzMercuryMiniMitsubishiNissanOldsmobilePontiacPorscheSaabSaturnSabaruSuzukiToyotaVolkswagonVolvoTypeVehicle # 4 model:*Vehicle # 4 Vehicle Identification Number (VIN):*Vehicle # 4 annual mileage:*Vehicle # 4 distance (one way) to work or school:*Vehicle # 4 original vehicle cost:*Vehicle # 4 kept at home address:*YesNoVehicle # 4 days driven to work or school:*select...1234567Vehicle # 4 ownership:*select...Paid forMaking PaymentsLeasedVehicle # 4 type of anti-theft device:*select...1) None2) VIN etching and ignition or starter cut off switch3) Number 2 plus at least two of the following: glass sensor, vibration sensor, motion sensor or ultronic sensor4) Number 3 plus a hood lock/latch and backup battery5) Number 4 plus an active alarm6) Number 5 plus a vehicle recovery device7) OtherVehicle # 4 primary use:*select...To/from workJust for pleasureSchoolBusiness callsDeliveryFarm or ranchClergymanArtisanfedGovernment/otherVehicle # 4 registration:*select...Applicant onlySpouse onlyApplicant and spouseApplicant and/or spouse and child under the age of 23Leasing companyOther Protection Review In order to properly protect your assets, its important that we have complete information about your total account. Some of the questions determine if you are eligible for premium discounts. Complete Section # 7 - Protection ReviewWhen does your home policy expire:* MM DD YYYY Who is your current company for homeowners insurance:Do you have a vacation home?*YesNoN/ADo you have rental property?*YesNoN/ADo you have household members away at school?*YesNoN/AIs the property prone to flooding or located in a designated flood plain?*YesNoN/AIs business or farming conducted on the property?*YesNoN/ADo you have any income-producing hobbies?*YesNoN/ADo you have any art, guns or collectibles?*YesNoN/ADo you have jewelry that you would want replaced if it were lost or stolen while on vacation?*YesNoN/AIf you sewer backed up and your carpet was ruined, would you want it replaced?*YesNoN/AIn the event of death, would you want the mortgage on your home paid off?*YesNoN/ADo you have an inventory of your household possessions?*YesNoN/AWould you prefer to lower your premium by choosing a higher deductible?*YesNoN/ADo you have any recreational vehicles such as boats or snowmobiles?*YesNoN/ADo you have coverage for Identity Theft Restoration?*YesNoN/AIf you were sued for $1,000,000 or more because you were at fault in an auto accident, or someone got hurt on your property, would you expect your insurance to pay?*YesNoN/AIf you had a chronic illness that left you unable to care for yourself for an extended period or time, do you expect to be covered by insurance?*YesNoN/A Comments & Approval Credit history:*select...ExcellentGoodSome Credit ProblemsMajor Credit ProblemsBankruptcy 3-6 Years AgoBankruptcy 1-3 Years AgoComments and questions (optional):Enter a short description that you can use for future reference (Optional):This description will display in the file cabinet which contains your complete transaction history.By clicking the Submit Button you are agreeing to the Terms Conditions of doing business with our agency via the Internet.Please enter your initials to sign this quote:* Why Purmort & Martin Insurance? "We don't answer to shareholders, we answer to our Sarasota friends and neighbors." - Russ Bobbitt (partner) Click Here Contact Us Today!Don't Wait To Find Out You're Overpaying Call (941) 366-7070
