Auto Tune-up Information
| Coverage Options |
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| Part
1 - Bodily
Injury to others: |
$20,000/$40,000 |
| Part
2 - Personal
Injury Protection: |
$8,000 |
| Part
3 - Uninsured
Motorist: |
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| Part
4 - Property
damage: |
$100,000 |
| Part
5 - Optional
Bodily Injury: |
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| Part
6 - Medical
Payments: |
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| Part
7 - Collision
(deductible): |
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| Part
8 - Limited
Collision: |
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| Part
9 - Comprehensive
(deductible): |
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| Part
10 - Substitute
Transportation: |
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| Part
11 - Towing
and Labor: |
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| Part
12 - Underinsured
Motorist: |
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Please note, in order for Ellis Insurance to provide an automobile insurance quotation, we must use information from the MA Registry of Motor Vehicles. Please select Yes to indicate your acceptance:
Yes
Home Tune-up Information
yes
| Residence Info |
Type of policy (homeowners,
condo, renters):
|
Effective
date of coverage:
|
Location
of residence
(if different from above):
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Is this
a Primary or Secondary residence:
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Approximate
year of construction:
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Construction
type:
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Any losses
in the last 3 years:
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Number
of families:
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| Coverage Info |
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| Value
of home, or amount of current insurance: |
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Personal property
amount
(condo
and renters only): |
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| Personal
Liability (each occurrence): |
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| Deductible: |
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| Endorsements |
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| Replacement
cost options
(check all that apply): |
Dwelling:
Contents:
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| Protective
devices
(check all that apply): |
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| Optional Coverages |
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| Earthquake
Coverage: |
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| Flood
Coverage: |
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Scheduled
Property
(enter an amount for all that apply): |
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Business Tune-up Information
Please provide some general information on your business. We will contact you for additional information based on the information provided:
Professional Liability
I would like a quote on (check all that apply)
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