Clark Insurance Agency


insurance

Insurance Quotes available for California residents Only

Automobile Insurance - Clark Insurance Agency offers Automobile Insurance Discounts for Good Drivers, Non-Smokers, Good Students, Senior Drivers, Multiple Car Discount, Auto/Home and Educational Discounts such as 55 alive and Youth Education and Safety courses. We offer Automobile insurance coverage for the State Law Minimum Liability Insurance requirements as well as Full Automobile Coverage Insurance. We can provide insurance for your cars, trucks, motorcycles, campers, motor homes, boats, jet skis, Hi-performance cars, sport cars and commercial vehicles. 
 
Discounts available for:

Auto/Home Pkg
Multicar Household
Non-Smoker
Good Driver Record
Good Student
Youth Education in Safety
Air Bag Equipped Autos
ABS EquippedAutos
Also Insuring:
Sports Cars
4 Wheel Drive
High Performance
Motorcycles

Driving to Work?

LA FREEWAY & EARTHQUAKE INFO

Auto Insurance Quote

Please fill out the form Completely. 
Name:                          

Sex:                           

Marital Status:                 

Company(opt):                  


Address:                       
                               
County:		

City:                            State: CA
Zip Code:(Required!)            

Current Insurance Company:     
Current Renewal Date:          

Current Annual Premium:        

Number of Drivers:             

Number of Cars:                











                     DRIVER INFORMATION: 

Name Drv. 1:                     

Sex:                           
Age Drv. 1:                    

# Minor Citations:             
# Major Citations:             
# Chargeable Accidents:        
If so,was there any injuries?  


Name Drv. 2:                     

Sex:                           
Age Drv. 2:                    

# Minor Citations:             
# Major Citations:             
# Chargeable Accidents:        
If so,was there any injuries?  


Name Drv. 3:                     

Sex:                           
Age Drv. 3:                    

# Minor Citations:             
# Major Citations:             
# Chargeable Accidents:        
If so,was there any injuries?  



Name Drv. 4:                     

Sex:                           
Age Drv. 4:                    

# Minor Citations:             
# Major Citations:             
# Chargeable Accidents:        
If so,was there any injuries?  

Yr./Make/Model: 
Auto Seat Belt: Air Bag:  4Whl Anti-Lock Brakes: 
Coverage:  Liab. Limits (Req'd by law): 
Uninsured Motorist Cov? 
Comprehensive Cov Deductible:  Collision Cov Deductible: 

Yr. Make Model: 
Auto Seat Belt: Air Bag:  4Whl Anti-Lock Brakes: 
Coverage:  Liab. Limits(Req'd by law): 
Uninsured Motorist Cov? 
Comprehensive Cov Deductible:  Collision Cov Deductible: 
Yr. Make Model: 
Auto Seat Belt: Air Bag:  4Whl Anti-Lock Brakes: 
Coverage:  Liab. Limits(Req'd by law): 
Uninsured Motorist Cov? 
Comprehensive Cov Deductible:  Collision Cov Deductible: 
Yr. Make Model: 
Auto Seat Belt: Air Bag:  4Whl Anti-Lock Brakes: 
Coverage:  Liab. Limits(Req'd by law): 
Uninsured Motorist Cov? 
Comprehensive Cov Deductible:  Collision Cov Deductible:  
Rental Car Coverage? 

Towing Coverage?     

Distance (1way) to work/school:

Average miles driven per year: 
Please include a valid email address and phone/fax number, how you'd prefer to be contacted and the best time and day. (Note: For a return quote please leave a fax number if available.)

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(877) 633 - 3454
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