DAVENPORT and WIGGINS Insurance Agency

 

Since 1932

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Please enter information below. IF A "REQUIRED" FIELD IS NOT APPLICABLE, PLEASE ENTER AN "X". New customers may use this page as a convenient way to submit information for a new auto insurance quotation. Existing customers may use this page as a convenient way to submit information for an update to their existing policy. The accuracy of quotes for new clients are subject to results of MVR/Loss Report history, Insurance Score, and any other issues which may affect the insurance underwriting and rating; underwriting guidelines and rates are subject to change and determine an issued policy's final premium.
 
A copy of your current Auto Declarations Page would be very helpful.  If you would like to provide that, please fax it to 214-764-6670.

The fields marked with (*) are required fields.

*
Please Enter: Primary Name for Policy/ DOB/ Drivers License #/ Address/ City/ Zip/ Contact Information
(Please at least enter email address as "Contact Information", to receive emailed quote)

*
Additional Drivers Names, DOBs and Relationship (Enter "0" or "None", if none)

*
List Tickets/Accidents in the Last Three Years by Driver (Enter "0" or "None", if none)


Please Enter Make and Model Information on Autos;  VIN Numbers Preferred
     


Names of Any Household Students Who would Qualify for the Good Student Discount (3.0/B Average or Better) and/or Any Household Students away at College (100+ Miles) with NO Auto
     


A Farmers Life Insurance Policy in the Household Gives an Additional Premium Discount. Would You be Interested in Receiving an Additional Quotation Including that Discount?
Yes
No
 
Please enter coverage required for each Auto. Note that under Texas Department of Insurance Rules, all cars within the same household have to have the same liability coverage. Liability coverages are defined by the State as: BI/PD, UMBI/UMPD, and Medical/PIP.   However, only BI/PD (Bodily Injury and Property Damage) are required by the State.


Select Bodily Injury (BI) and Property Damage (PD) Coverage - "25/50/25" is State Required Minimum Coverage
BI 25/50
BI 50/100
BI 100/300
BI 250/500
BI 500/500 (Required for Personal Umbrella)
PD 25
PD 50
PD 100 (Required for Personal Umbrella)


Select Uninsured/Underinsured Bodily Injury (BI) and Property Damage (PD) Coverage (A selection is required, but the coverage is optional)
UMBI NONE
UMBI 25/50
UMBI 50/100
UMBI 100/300
UMBI 250/500
UMPD NONE
UMPD 25
UMPD 50
UMPD 100


Select a Medical or PIP Coverage (A selection is required, but the coveage is optional)
 
Comprehensive, Collision, Road Side Assistance, and Rental Reimbursement Coverages are Optional. If a Coverage is Desired, Please Mark Appropriately for Each Auto IN THE ORDER LISTED ABOVE.
 
1st Auto
100 - Comprehensive Deductible
200
250
500
750
1000
250 - Collision Deductible
500
750
1000
40 - Towing and Roadside Assistance
80
120
20 Day/600 Total - Rental Reimbursement
25/750
30/900
35/1050
 
2nd Auto
100 - Comprehensive Deductible
200
250
500
750
1000
250 - Collision Deductible
500
750
1000
40 - Towing and Roadside Assistance
80
120
20 Day/600 Total - Rental Reimbursement
25/750
30/900
35/1050
 
3rd Auto
100 - Comprehensive Deductible
200
250
500
750
1000
250 - Collision Deductible
500
750
1000
40 - Towing and Roadside Assistance
80
120
20 Day/600 Total - Rental Reimbursement
25/750
30/900
35/1050
 
4th Auto
100 - Comprehensive Deductible
200
250
500
750
1000
1250
250 - Collision Deductible
500
750
1000
40 - Towing and Roadside Assistance
80
120
20 Day/600 Total - Rental Reimbursement
25/750
30/900
35/1050
 
5th Auto
100 - Comprehensive Deductible
200
250
500
750
1000
250 - Collision Deductible
500
750
1000
40 - Towing and Roadside Assistance
80
120
20 Day/600 Total - Rental Reimbursement
25/750
30/900
35/1050
 
Please enter any general comments or additional information related to this quotation request, which may be important for accuracy.
 
Comments/Additional Information