Berg Insurance

Auto Insurance

The state of California makes it possible for you to purchase a minimal amount of Liability Insurance to register your vehicle. But when you look at the other cars on the road, $5,000 in Property Damage Liability just doesn’t seem like enough when an accident occurs. By letting us know a little bit about your current situation, we can evaluate your needs and exposure to provide coverage that makes sense when driving around Southern California, and put you at ease behind the wheel. You’ll know, after speaking to one of our insurance professionals, that you are properly insured.

Call Today for a free quote 800-989-7990

AUTO INSURANCE
Requested By:
First Name:		Last Name:
Home Phone:		Work Phone:
Property Address:
Mailing Address (if different):
Driver Information:
First Name:		Last Name:
Marriage Status:		Relation to Person Requesting:
Date of Birth:		Date 1st Licensed Issued:
Drivers License #		Occupation:
Current Carrier Info:
Current Carrier:		Policy Number:
Renewal Date:		Good Student:
Any Tickets:		If Yes Explain:
Any Accidents:		If Yes Explain:
Amount Paid by Carrier:
Vehicle Information:
Year, Make, Model:	golf, volks, 2003
VIN:		Driven by:
Annual Miles:		Miles to/from Work/School:
Desired Limits:
Bodily Injury Liability:	$	Property Damage Liability:	$
Uninsured/Underinsured Motorist Liability:	$	UMPD waiver:
Medical Coverage:	$	Comprehensive Deductible:	$
Collision Deductible:	$	Towing:
Rental Car:
Comments: