TX insurance
Texas insurance
New York Homeowners, Auto, Business and Other N.Y. Insurance Solutions
Find Out Why We Are New York's Online Insurance Sales & Service Leader!
TX insurance

TX life insurance
TX insurance
Visit Our Agency's
Valuable New York
Insurance Resources:
Texas ins

 

  Auto Insurance Quote
  Homeowners Quote
  Flood Insurance Quote
  Renters Insurance Quote
  Boat/Watercraft Insurance
  Motorcycle/ATV Quotes
  Umbrella Insurance Quote

  Life Insurance Quote
  Long Term Care Quote

  Business Owners Quote
  Contractor Liability Quote
  Professional Liability Quote
  Apartment Bldgs. & Condos
  Directors & Officers Liability
  Employment Practices Liability

  Special Event Insurance
  Waterfront Home Insurance
  Plans for Canceled Auto Ins.
  Plans for Canceled Home Ins.

  Service My Account
  Our Privacy Statement
  Norton & Siegel Corporate Site
  Return to Home Page

Questions?
Ask the
Agent!

 
E-mail Questions to:
sales@norton
andsiegel.com

 

Toll-Free: 1-866-669-0365
Phone: 1-631-669-0365
Fax: 1-631-669-0158

Contact Address:
Norton & Siegel, Inc.
PO Box 220
Babylon, NY 11702

"Remember, All Our Policies Come With an Agent!"
On-Line Automobile
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data

Your Name:
Street Address:
City:
State:
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Marital Status:
Single Married
Homeowner?
Yes No
 
Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)


DRIVER INFORMATION #1
Name: Birthdate:
Sex (M/F): # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR Cites last 3 years:
Number & Type of MAJOR Cites last 3 years: Daily commute
in ONE WAY miles:


DRIVER INFORMATION #2 (if none, leave blank)
Name: Birthdate:
Sex: # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR Cites last 3 years:
Number & Type of MAJOR Cites last 3 years: Daily commute
in ONE WAY miles:
If More than 2 Drivers, list Additional Driver's Names, Birthdates, and driving record history here:


VEHICLE #1 INFORMATION
(if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
Year of vehicle: Make & Model:
Vehicle ID# (for rating accuracy):
Annual Mileage: Used in business?
(Explain, if yes):
VEHICLE #1 COVERAGES:
Select Liability Limits
 
Select Comprehensive Deductible:
 
Select Collision Deductible:
 
Uninsured Motorists
Coverage?
YES NO
 
Rental Car &
Towing Coverage?
YES NO
 
Medical and/or
PIP Coverage:
 
 
VEHICLE #2 INFORMATION (if none, leave blank)
Year of vehicle: Make & Model:
Vehicle ID# (for rating accuracy):
Annual Mileage: Used in business?
(Explain, if yes):
VEHICLE #2 COVERAGES:
Select Liability Limits - - - Liability Limits Must
Match Vehicle #1 - - -
 
Select Comprehensive Deductible:
 
Select Collision Deductible:
 
Uninsured Motorists
Coverage?
YES NO
 
Rental Car &
Towing Coverage:
 
Medical and/or
PIP Coverage?
YES NO
 
Comments or Remarks:
(List additional drivers, autos, etc. here)
If More than 2 Vehicles or Drivers, list Additional Vehicles Year, Makes, and Models, and Driver's Ages and Driving records here:


Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone!

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me an Auto Quote NOW!


Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!


Norton & Siegel, Inc. | PO Box 220 | Babylon, NY 11702 | Phone: 1-631-669-0365 | Fax: 1-631-669-0158
Map/Office Driving Directions | Terms of Use/Privacy Notice/Copyright Info.   | Design 2006 Insurance-Web-Sales
More About Our Agency | Please report site-related technical problems to: sales@nortonandsiegel.com