Auto Dealers
The Cusmano Agency
1595 Black Rock Turnpike Fairfiled, CT 06825
Toll Free:877-394-6643, 203-394-6645, FAX:203-394-6646


Home
Auto Quote
Home Quote
Commercial
Life
Health
Mortgage Brokers
Auto Dealers
Contact Us
CT DMV
Kelly Blue Book

Auto Dealer Insurance Quote

Please fill out the information below for a fast and courteous quote

Dealership Information:

Dealership Name:

Address:

City:    State:    Zip:

Sales Person:    Email:

Phone:    FAX:

Client Information:

First Name:    Last Name:

Address:   

City:    State:    Zip:

Do you own your own home or Rent? Own:    Rent:

Home Phone:       Work Phone:

Mobile Phone:    Email:

Driver Information:
  Driver 1 Driver 2 Driver 3 Driver 4
Name:
DOB:
SS:
DL#:
A/V

Explain any accidents or Violations:

Current Insurance Company:    Renewal Date:

Auto Information:

  Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5
Year
Make
Model
Comp Ded
Full Glass

Coll. Ded.
Liab Limits
Med Pay
Prop Limits
UMC Limits
Rental Car
Towing

Notes: