How many vehicles do you own or lease?

Are you considering getting a new car in the near future? Yes     No

Have you paid any of your cars off? Yes     No

Do you own an Hybrid or Electric cars? Yes     No

Do you have any antique cars? Yes     No

Do any of your cars have an anti- theft device?
Yes     No

Do you have a motorclub membership, AAA etc.?
Yes     No

Do you have any children at or near driving age ? If so please list their names and dates of birth.
 

If you have children driving do they have a GPA of 3.0 (B) or better? Yes     No

Have you or your children (if any driving) attended advanced driving school? Yes     No

Do you own a boat or any other watercraft? Yes     No

Have you recently purchased a motor home or travel trailer? Yes     No

Do you own a utility trailer? Yes     No

Phone:

Email:

Insured Signature: (please type name)

Date:

Thanking you in advance for taking the time to complete this questionnaire. As always, if you may have any questions please contact us at (508) 533-8914.

Testimonial
Ted,
Just a short note to say thanks for getting me great price on my car and home insurance. With all the new insurers now competing for my business by promising to "beat" what I am currently paying I didn't think Reardon Insurance could compete with some of their prices. Well, you proved me wrong. You continue to earn my business every year with competitive pricing and great service from your staff.
Brian
Mendon, MA