Home
Meet Agency
Get Quotes
Products and Services
Claims
Location
Contact Us

Auto Insurance Quote

Step 1 of 5

20%

PERSONAL INFORMATION
Name
FirstLast
Address
Street AddressAddress Line 2CityStateZip Code
Email
Home Phone
(###)###-####
Work Phone
(###)###-####

TELL US ABOUT YOUR VEHICLE
How many vehicles do you own?*
Vehicle One
Year
Make
Model
Does this vehicle have an airbag?
- Yes
- No
What is the VIN number on this vehicle?
Vehicle Two
Year
Make
Model
Does this vehicle have an airbag?
- Yes
- No
What is the VIN number on this vehicle?
Vehicle Three
Year
Make
Model
Does this vehicle have an airbag?
- Yes
- No
What is the VIN number on this vehicle?
Vehicle Four
Year
Make
Model
Does this vehcile have an airbag?
- Yes
- No
What is the VIN number on this vehicle?

TELL US ABOUT YOUR DRIVERS
How many drivers will need to be insured?*
If any Drivers are Under the age 25
- Going to School Right Now
- Driver Ed Completed
- Have Children
Driver One
Name
FirstLast
Date of Birth
Marital Status
- Yes
- No
SSN
Drivers Licence Number
If not SC please replace with appropriate state abbreviation.
Driver Two
Name
FirstLast
Date of Birth
Marital Status
- Yes
- No
SSN
Drivers Licence Number
Driver Three
Name
FirstLast
Date of Birth
Marital Status
- Yes
- No
SSN
Drivers Licence Number
Driver Four
Name
FirstLast
Date of Birth
Martial Status
- Yes
- No
SSN
Drivers Licence Number

DESIRED INSURANCE POLICY
In the last 3 years have you had any accidents or claims? If so please explain...
In the last 5 years have you had any minor or major violations? If so please explain...
Desired Comprehensive Deductible
- 0
- 100
- 250
- 500
Desired Collision Deductible
- 100
- 250
- 500
- 1000
Desired Liability
- 25/50/25
- 50/100/50
- 100/300/100
- 300/300/100
Other Services Desired
- Rental Car
- Towing Service

CURRENT INSURANCE POLICIES
Do you currently have auto insurance?
- Yes
- No
Do you rent or own your home?
- Rent
- Own
Do you have insurance on your home?
- Yes
- No
Do you have renters insurance?
- Yes
- No
Do you have life insurance?
- Yes
- No
Where do you bank?
How did you hear about us?
Comments
This field is for validation purposes and should be left unchanged.

Leave a Reply

Click here to cancel reply.

Name *

Mail (will not be published) *

Website

Client Testimonials

I am completely satisfied with my relationship with the Pitts Insurance Team. I have been with you all since July 1994 and I am definitely “On Your Side” for good!

Lisa D Mumford, Columbia, SC 7/11/11

NE Columbia Office

9450 Two Notch Rd.
Columbia, SC 29223
(Across from Spring Valley Subdivision)
Phone: 803.788.1342
Fax: 803.736.8139
Hours: Mon.-Fri.: 8:30-5:30, Sat: By Appointment

Alumni Discounts!

The Pitts Insurance Team is offering discounts to USC Alumni! Every policy purchased will help support your University.

Newsletter

Subscribe to James Pitts Insurance

Get the latest updates delivered via email

James Pitts Insurance
Copyright © 2012 All Rights Reserved

Log in
Site Designed By Web Design Greenville SC

thomas davis thomas davis