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AAW Insurance Free Quote

		DRIVER (REGISTERED OWNER)
City or Town of principal garaging
	Name
	Driver's License No. (MA Only)
	Daytime Phone
	Fax (if available)
	Email Address
If presently or in the last 6 years you held an auto of state license, please describe briefly your driving record in the remarks section
	Drivers ED.	Yes	No
Additional Driver
	Name
	Driver's License (MA Only)
	How long you've been licensed
		VEHICLE
	Make (Chevy, Honda, etc.)
	Model (Be specific: Civic LX, etc.)
	Body Style (Wagon, Sedan, Van, etc.)
	Year of Vehicle
	Number of miles driven in the past 12 months	0 - 5000 miles per year 5001 - 7500 miles per year Over 7500 miles per year
COVERAGES
Click on the coverage for brief description
	Bodily injury caused by any insured auto	$20,000 / 40,000 Mandatory $25,000 / $50,000 $50,000 / $100,000 $100,000 / $300,000 $250,000 / $500,000 Higher Limits
	Other limits available
	Damage to someone else's property	$5,000 Mandatory $10,000 $25,000 $50,000 $100,000 Higher Limits
	(Dependable on Uninsured, Underinsured Limits)
	Optional body injury to others	No Coverage $25,000 / $50,000 $50,000 / $100,00 $100,000 / $300,000 $250,000 / $500,000 Higher Limits
	Medical Payments	No Coverage $5,000 $10,000 $25,000 Higher Limits
	(If you don't have health coverage)
	Collision (Required if Auto Financed or Leased)
	Deductible	No Coverage $300 deductible $500 deductible $1,000 deductible $2,000 deductible
	Comprehensive Deductible	No Coverage $300 deductible $500 deductible $1,000 deductible $2,000 deductible
	Required if Auto Financed or Leased)
	Substitute Transportation	No Coverage $30 per day / $500 max $45 per day / $1,350 max Higher Limits
	Towing and Labor	No Coverage $50 per disablement $100 per disablement
	Bodily Injury Caused by Underinsured Motorists	$20,000 / $40,000 $25,000 / $50,000 $50,000 / $100,000 $100,000 / $300,000 $250,000 / $500,000
	Remarks or Comments any out of state driving record for the past 6 years
	How do you like us to contact you back	Email Daytime Phone Fax Mail