Auto Insurance Quote
Please fill out the short form below. If you have it available, please send your current declaration page to toditah@wexfordins.com so we can compare coverages.
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DRIVER INFORMATION
Full Name, Date of Birth, Driver's License #, Gender, (Occupation & Highest Level of Education for discount purposes) & Marital Status *
Primary Policy Holder
What is your current address? *
Ex: 123 Main Street City, State Zip Code & Apt/Unit # if applicable
Age when first licensed *
Phone Number & Email *
Additional Drivers *
Please list full names, birthdays, genders, driver's license #, (occupations for discount purposes) & marital status of any additional drivers. If no additional drivers, type NONE. 
SR-22 |  Certificate of Financial Responsibility *
Does any driver on the policy require an SR-22? Please specify the drivers. If no, type NO
VEHICLES
Please provide the information below for each household vehicle.
Year, Make, Model, VIN#, Vehicle Purchase Date (Found on Registration) & Ownership status (owned, leased or loan) *
 If you have already sent your declaration page, type the date of purchases for each vehicle.
Do you currently have insurance, if so with who? *
 If no current insurance, type NO. Please send your current declaration page to toditah@wexfordins.com so we compare what you already have. 
Lienholder *
Please list the name and address if you have it of the company that financed your vehicle(s) if applicable. Lienholders require insurance so we'll need their contact information to send them proof. If no lienholder type NONE
Deliveries/Transportation *
Do you pick-up or deliver goods (newspapers, pizza, other food/items, etc.), or the transport people (limousine, taxi, etc.)?
Rideshare *
Do you drive for Uber, Lyft, DoorDash, UberEats, etc. 
Permission to Run Reports *
In order to get the most accurate quote possible, insurance companies run reports which contain vehicle, driving and claim histories as well as gather information from credit reports to generate a credit based insurance score and properly rate your policy. This is NOT a hard pull on your credit and we do NOT ask for your social security number. Only your vehicle, driving and claim history are shared with the agent, not your credit report. Motor Vehicle Reports are required before an insurance company can bind a policy. Do we have permission to run reports in order to give the most accurate quote? If so, please type I Agree below. 
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