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Auto Insurance Form

Please complete the information below to obtain an auto insurance quote. We write with multiple carriers and we will use this information to find the best fit for you!






Have you lived there for at least 3 years?

Yes
No
 

How did you hear about Greylock Insurance Agency?

Online
GFCU Member
Friend/Family
Other
 

Are you a Greylock Federal Credit Union Member?

Yes
No
 
Best phone contact

Cell
Home
Work
 




Are you currently insured?

Yes
No
 


Have you ever been cancelled or non-renewed?

Yes
No
 

Do you have accident forgiveness or disappearing deductibles?

Yes
No
Unsure
 
Do you have a home, renters, or condo policy that you currently bundle with?

Yes
No
 

In the state of MA, they require that all licensed members of your household, or anyone who regularly drives your vehicle, be listed as drivers on your policy.
Please list yourself and any other operators you live with:






Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed
Do any of the above operators have their own insurance policy?

Yes
No
 
Are any drivers a full time student?

Yes
No
 
Do they have a B average or better?

Yes
No
 
Is the student away at school?

Yes
No
 
Does the student have the vehicle at school with them?

Yes
No
 

Has any operator been licensed out of state?

Yes
No
 


Please list all vehicles/motorcycles/campers that you own:








Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed

Only use if needed
Are any of the vehicles you listed above a Motorcycle or Camper

Motorcycle
Camper
No, they are not
 



Are any of the vehicles used for ride share such as Uber/Lyft or for food delivery such as Doordash/Grubhub/Instacart?

Yes
No
 

Are any of the vehicles used for any other kind of business?

Yes
No
 

Do you tow anything such as a trailer or camper with any of your vehicles?

Yes
No
 


Do any of the vehicles have a snow plow?

Yes
No
 


Are you a AAA member?

Yes
No
 

We will need a copy of your current auto insurance policy to quote. Please use the following upload feature to upload your files to us. Thank you.


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