We Specialize in South Carolina Term & Whole Life Insurance Plans
Lowest Term Life and Universal Life Insurance Rates in the State!
We shop multiple plans so YOU SAVE MONEY!
FAST policy issuance - we start the application on the phone!
Our superior customer service tailors a plan for YOUR budget.
Best Medicare Supplements!
We Have the BEST Medicare Supplements!
We EXPLAIN your options.
We shop top SC carriers.
Guaranteed Lowest Rates!
INSTANT Phone Quotes!
Superior Agents and Quality Customer Service!
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 violations last 3 years:
Number & Type of MAJOR violations last 3 years:
Daily commute in ONE WAY miles:
Does Driver need an SR22 FILING?
Yes
No
If YES to SR22 filing, why needed? (list accident/cite)
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 violations last 3 years:
Number & Type of MAJOR violations last 3 years:
Daily commute in ONE WAY miles:
Does Driver need an SR22 FILING?
Yes
No
Comments or Remarks?
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?
YES
NO
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?
YES
NO
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:
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