FrankSlaughterInsurance.com

Our agency is excited to offer a home and auto package policy with AAA Auto Club Insurance Company of Florida.

Auto Insurance Quote

To obtain a free, no-obligation quote for your car or other personal vehicle, fill out the form below and we will contact you. If you prefer to give information over the phone, fill out the highlighted areas only and we'll give you a call.

(*) Name and at least one contact number is required to submit quote form.

Name *
Physical Address
City	State Zip
Mailing Address
City	State Zip
Home Phone *	Work Phone
Email (requested)

Have you had continuous coverage for at least 12 months?	Yes No
If not, why not?
Current Insurance Co.
Renewal Date

Own you own your Home?	Yes No
Do you have an Umbrella?	Yes No
Do you have liens on any of your autos/recreational items?	Yes No

Car#1
Year	Make	Model
2dr/4dr	Miles to Work (one way)	Annual Mileage
Type of Anti-Theft Device on Vehicle
Vin #

Car#2
Year	Make	Model
2dr/4dr	Miles to Work (one way)	Annual Mileage
Type of Anti-Theft Device on Vehicle
Vin #

Car#3
Year	Make	Model
2dr/4dr	Miles to Work (one way)	Annual Mileage
Type of Anti-Theft Device on Vehicle
Vin #

Car#4
Year	Make	Model
2dr/4dr	Miles to Work (one way)	Annual Mileage
Type of Anti-Theft Device on Vehicle
Vin #

Driver #1 Information
Driver Name
Occupation
Date of Birth
Drivers License Number
Social Security Number	Many of the companies we represent require this information prior to quoting.
Gender:	Male Female
Marital Status
Moving Violations in Last 3 Years	0 1 2 3
Please provide the date and a brief description of each violation.
Accidents in Last 3 Years	0 1 2 3
Please provide the date and a brief description of each accident.

Driver #2 Information
Driver Name
Occupation
Date of Birth
Drivers License Number
Social Security Number	Many of the companies we represent require this information prior to quoting.
Gender:	Male Female
Marital Status
Moving Violations in Last 3 Years	0 1 2 3
Please provide the date and a brief description of each violation.
Accidents in Last 3 Years	0 1 2 3
Please provide the date and a brief description of each accident.

Driver #3 Information
Driver Name
Occupation
Date of Birth
Drivers License Number
Social Security Number	Many of the companies we represent require this information prior to quoting.
Gender:	Male Female
Marital Status
Moving Violations in Last 3 Years	0 1 2 3
Please provide the date and a brief description of each violation.
Accidents in Last 3 Years	0 1 2 3
Please provide the date and a brief description of each accident.

Driver #4 Information
Driver Name
Occupation
Date of Birth
Drivers License Number
Social Security Number	Many of the companies we represent require this information prior to quoting.
Gender:	Male Female
Marital Status
Moving Violations in Last 3 Years	0 1 2 3
Please provide the date and a brief description of each violation.
Accidents in Last 3 Years	0 1 2 3
Please provide the date and a brief description of each accident.

Liability Limit for All Cars

Choose either Bodily Injury & Property Damage OR Single Limit

Bodily Injury	Property Damage
25,000/50,000	25,000
50,000/100,000	50,000
100,000/300,000	100,000
250,000/500,000	500,000

Single Limit
choose one

50,000

100,000

300,000

500,000

Level of current Uninsured Motorist coverage

Car #1
Deductible Comprehensive	100	250	500
Deductible Collision	250	500	1000
Towing	Yes
Rental Car Coverage	Yes

Car #2
Deductible Comprehensive	100	250	500
Deductible Collision	250	500	1000
Towing	Yes
Rental Car Coverage	Yes

Car #3
Deductible Comprehensive	100	250	500
Deductible Collision	250	500	1000
Towing	Yes
Rental Car Coverage	Yes

Car #4
Deductible Comprehensive	100	250	500
Deductible Collision	250	500	1000
Towing	Yes
Rental Car Coverage	Yes

Please provide information on any recreational items such as golf carts, boats or ATVs

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