The Insurance House all lines insurance agency offering car, health, life, house, property, business, collector, boat, rental insurance located in Floral Park, Long Island, New York

Car, Auto, Truck Insurance Request info of The Insurance House all lines insurance agency offering car, health, life, house, property, business, collector, boat, rental insurance located in Floral Park, Long Island, New York!

DRIVER INFORMATION
Name:
Address:
City:
State:	New York State Only
Zip:
Phone:
Fax:
E-mail:
Age:
Marital Status:
Years Licensed:
Driving Record: (accidents / violations)	Please, list in detail.
Defensive Driving?
Drivers License #:
Social Security #:
Previous Insurance:
VEHICLE INFORMATION
Year:
Make:
Model:
Discounts:	abs airbags alarm daytime running lights
TYPE OF COVERAGE DESIRED:

Bodily Injury:	25/50 50/100 100/300 250/500
Property Damage:	10K 25K 50K 100K
Sum:	25/50 50/100 100/300 250/500
Pip Coverage:	50K Addl. 50K Addl. 100K Guest Full Obel
Comprehensive Ded:	$ 250 $ 500 $ 1,000
Collision Ded:	$ 250 $ 500 $ 1,000
Comments / Questions: