Online Quote - Northeast Classic Auto Insurance

To ensure a reliable quote, please complete form as accurately as possible.

Personal Information
Primary Driver’s Name*

First Last
Date of birth
Address Street Address

City State / Province / Region Zip
Home Phone
Work Phone
Fax Number
E-Mail Address*
Car To Be Insured

(If you have more than one car, please list info in the "Questions Or Comments" section at the bottom of this form.)
Year*
Make*
Model
Value*
Annual Mileage
Status

Stock Modified
Is the car to be garaged?*

Yes No
List any traffic violations, accidents and the dates
Complete if you are married
Married

Yes No
Spouse’s name

First Last
Spouse’s date of birth
List any of your spouse’s traffic violations, accidents and the dates
Complete for children of driving age living at home
Number of children 16-25 years old

don't insert any value if none
Current insurance information

15% transfer discount available in many states from existing classic car insurance carriers
How many regular use vehicles do you own?
What is your current amount of liability coverage?
What is your current amount of uninsured motorist coverage?
Who is your current insurance carrier?
Questions or comments

Northeast Classic Auto Insurance