Auto Information
 
 

Model
Type 

    # of   
    Doors    

     Driver           Annual
     % Used        Miles Driven

 
      Driver Information
 
                                                                                                                                                                                                                                                                                       Accidents     

  Date of 
  Birth  

Non-Fault

M F

  0 1 2 3 4 5 6+

M F

  0 1 2 3 4 5 6+

M F

0 1 2 3 4 5 6+

M F

0 1 2 3 4 5 6+

M F

0 1 2 3 4 5 6+

 
Desired Coverage Limits
  

   Bodily Injury

$15,000-$30,000 $25,000-$50,000 $30,000-$60,000 $50,000-$100,000 $100,000-$300,000 $250,000-$500,000 $1,000,000 Single Limit

 Collision 

Comprehensive                 Rental Coverage

$ 0 $ 100 $ 200 $ 250 $ 500 $ 1,000 No_Coverage

$ 0 $ 100 $ 200 $ 250 $ 500 $ 1,000 No_Coverage   

$ 0 $ 100 $ 200 $ 250 $ 500 $ 1,000 No_Coverage

$ 0 $ 100 $ 200 $ 250 $ 500 $ 1,000 No_Coverage

$ 0 $ 100 $ 200 $ 250 $ 500 $ 1,000 No_Coverage

$ 0 $ 100 $ 200 $ 250 $ 500 $ 1,000 No_Coverage

$ 0 $ 100 $ 200 $ 250 $ 500 $ 1,000 No_Coverage

$ 0 $ 100 $ 200 $ 250 $ 500 $ 1,000 No_Coverage

Policy Expires (Month / Date)   

Policy Expires (Month / Date)   

 
Ask us about out Home /Auto Discount!

    Insurance & Notary Services
     
    Auto Insurance Disclosure Statement
    Please Read Below

   Thank you for the opportunity to discuss your Auto insurance needs. I look Forward to
   offering you the service and value that is the standard of Ronn Hall Insurance.  I am sure
   you will see hat this quote can affordable enhance your insurance program.
     
    Please Note:  An Insured which refuses to Provide coverage to an applicant who is a
   “Good Driver” Must provide the applicant with a written statement of the reasons it denied
   coverage. In general, under California law a “good driver” is a person who, during the last
   three years,  Has been continually licensed and has not had more than one violation point or
   more than One at-fault accident resulting in only property damage.
                  
   As part of the application process, Our Insurance Co. may collect personal information from
   Persons other than you or other individuals proposed for coverage, including credit reports,
   loss information reports and motor vehicle reports.  This information, as well as other personal
   or privileged information subsequently collected by us, may in certain circumstances be
   disclosed to third parties without your authorization.  You have a right of access and correction
   with respect to al personal information we collect. If you would like more detailed information
   in writing about our information collection practices,  please let us know    
   
   All coverage’s are subject to the Terms and conditions contained in the policy and
   endorsements. The premiums shown are for a 6-month policy period. 
   If you have any questions please call me at the Telephone number listed below. 
            
   
   Ask us about our Auto/ Home Discounts.
   01/27/2008