| Home Page | Telephone quotes or questions? 800-380-9928, fax 949-496-8354

horizontal rule graphic


Internet Auto Quote Request- Bob Heineman Brokerage.

California Residents Only Please!

Graphic Please answer all applicable questions for an accurate quote.


horizontal rule graphic

Graphic General Information:

First and Last Name Address

City County

State Zip

Your email address

Your telephone number or numbers

Who is your current insurance company ?

Your policy number?

How many years have you been continuously insured?

When does your current policy expire? horizontal rule graphic


coffee mug graphic Driver information:

Please list the names of all drivers in your household . Also include the age, sex and number of tickets and fault accidents for each driver for the past 3 years. If there are no tickets or accidents, please indicate none.

Driver 1 (applicant)

Age? Sex

Married?

# years licensed in U.S.

Occupation Do you smoke?

If student, 3.0 or better G.P.A. ?

# minor violations?

# major violations?

Suspended license or SR22?

# fault accidents?

Any injury accidents?

Comments: Briefly describe any tickets or accidents. Please provide dates.

If there are no more drivers in your household, skip down to Vehicle Information .
Additional Drivers.
Please provide the following information for additional drivers:

Name, Age, Sex, Married?, Smoke?, # years licensed in U.S., Driving record:

Please briefly describe any tickets or accidents for additional drivers. Provide dates:

horizontal rule graphic


| Back to Driver Information |


graphic Vehicle Information:

Year Make Exact model

Vehicle ID number if available

Two door or four door? Wagon or hatchback?

Convertible? Truck? Four wheel drive?

Four wheel A.B.S. ? Name of primary driver

Vehicle driven to work or school?

If YES, miles one way to work or school

Approximate annual mileage

Is vehicle used for sales, delivery, construction or other business use?

If YES, briefly describe use

List any safety features your vehicle has:

horizontal rule graphic


graphic Coverages:

Bodily Injury/Property Damage Liability

Uninsured/Underinsured Motorist

Uninsured Motorist Collision Deductible Waiver

Medical Payments

Comprehensive Deductible

Collision Deductible

Towing & Roadservice

Car Rental

Comments:

How did you find this Web site (Webcrawler, Yahoo, referred by a friend, etc.)?

horizontal rule graphic

You are now ready to submit your quote request. You will normally receive your quote back by email no later than the next business day.


to request your quote.

horizontal rule graphic

Copyright © 1995-2000 Robert T. Heineman. All rightsreserved. Last updated 10/18/2000. License # 0581377.





| Return to application |

Who is your current insurance company (not agent or broker)?

Please enter the name of your current insurance company. For instance, Allstate, State Farm, 20th Century, etc. Do not enter the name of the broker from whom you purchased your policy.

We ask for the name of your current insurance company to help qualify you for lower auto insurance rates. Statistically speaking, people that come to us with prior insurance are less likely to be involved in accidents than people without prior insurance.

We could speculate for days as to why this is the case. But, what ever the reason, people with prior insurance tend to have fewer accidents.

If you have insurance now, you may qualify for a lower rate with with some companies. That's why we ask.

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354






| Return to application |

Please list the names of all drivers in your household. Also include the age, sex...

Please list the name, age and sex of each licensed person living in your house. The absolute number of drivers in a household does not necessarily effect the rate you pay. The age, sex, marital status and driving record does effect rate.

For example, a household could consist of four licensed drivers all over age thirty, with clean driving records, and only one car. Another household may have one driver over thirty, with a poor driving record, and one car. Other things being equal, the first household with more drivers will have a lower auto insurance rate than the second household with only one driver. The poor driving record has a greater effect on the rate than the number of drivers.

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354






| Return to application |

Also include the ... number of tickets and fault accidents for each driver in the last 3 years.

The number of tickets in the last three years means the number of moving violations received in the last three years. Fix-it tickets generally do not count. Seat belt and car pool lane violations generally do count. In California, if a violation is over three years old it does not count, even if it is a major violation like drunk driving or reckless.

Fault accidents, for all practical purposes, are accidents for which you are completely or partially at fault. Most accidents are considered fault accidents for purpose of insurance rating.

Non-fault accidents are rare. Non-fault accidents are:


| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354






| Return to application |

Is the most frequent driver a full-time academic student with a G.P.A. of 3.0 or higher?

If the most frequent driver meets the following two criteria, a "Good Student" discount will be applied to your auto quote. The good student discount is significant. It can lower the overall premium by about 20%.

Good Student Discount Criteria.

  1. The most frequent driver is a full time academic (as opposed to vocational) student. A full time student is someone taking 12 or more units during the last academic period (quarter or semester).
  2. The most frequent driver has a grade point average (G.P.A.) of 3.0 or higher during the last academic period.

If the most frequent driver graduates from college with a G.P.A. of 3.0 or higher, while insured with some companies, they may retain their good student discount until age 25.

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354







| Return to application |


Vehicle ID number

The vehicle identification number is found on the vehicle registration. It is also usually found on the edge of the driver's door, on the dashboard above the steering wheel, and also sometimes found on your insurance policy. The vehicle ID number helps us to identify the exact year, make and model of your car.

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354







Exact model

Please enter the exact model with the descriptive "letters" or "codes" that often follow the model name. For instance there are many models of Honda Accord. There are Accord DX, LX, and LXI's. When you enter the model of your car please list the model including the descriptive letters or codes that usually follow the model name.

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354







Does this vehicle have four wheel anti-lock brakes?

To be eligible for the anti-lock brake (often abbreviated ABS for anti-lock braking system) discount, your vehicle must have anti-lock brakes on all four wheels. Some vehicles have ABS on only two wheels. Vehicles with two wheel ABS do not qualify for this discount.

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354







Primary driver.

Please list the name of the primary or most frequent driver for this vehicle.

If your household has more than one driver, and more than one vehicle, place a different driver on each vehicle.

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354






| Return to application |

Please list any other safety features...

Please list other safety features your car may have to help lower your quoted rate. Examples of other safety features are:


| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354






| Return to application |

Bodily Injury/Property Damage Liability (B.I.P.D.).

If you are at fault in an accident, bodily injury/property damage liability protects you against lawsuit, pays for other people's injuries, and fixes property you damaged during the accident.

B.I.P.D. does not pay for your injuries or damage to your car, just other peoples' to whom you are legally liable. B.I.P.D. pays for damages outside your vehicle. It pays for your passenger's injuries only if you are at fault, and your passengers are not members of your immediate family or household.

A common limit of liability is $100,000/$300,000/$50,000. This means if you are in an accident (that is your fault), your insurance company will pay up to $100,000 per person you injure, $300,000 maximum for all people you injure, and up to $50,000 in damage you cause to other people's property-- like cars, houses, etc..

These limits apply to a single accident only. So if you are involved in more than one accident, coverage starts all over again.

You have a wide variety of potential limits of liability to choose from. Limits commonly range from the California state minimum of $15,000/$30,000/$5,000 to a hefty $250,000/$500,000/$100,000. You can go even higher if you buy a personal umbrella.

How much liability insurance should you carry? There is no "cut and dried" answer to this question, but the answer relates to your financial net worth, how much premium you can afford to pay, and your moral feelings towards other people.

Your Financial Net Worth
The more assets you have-- money in the bank, property, stocks, a business, and other equities-- the more susceptible you are to lawsuit. If you own a home or are a typical "middle class" American, you should carry a minimum of $100,000/$300,000/$50,000 liability. As a "rule of thumb" your limit of liability should be at least be equal to your net worth. If your net worth exceeds $500,000, you should consider carrying a personal umbrella, which increases your liability coverage to more than $1,000,000. The cost of most personal umbrellas is relatively nominal ($200-$400 annually) compared to the vastly increased coverage.
Affordability
The higher your coverage, the more you will pay. There are trade-offs between how much you can afford or want to pay, how much insurance you need based on your net worth, and your feelings of moral responsibility towards other people if you hurt them.
Morality
Setting aside worries about lawsuit, if you cause an accident and seriously injure another person, would your conscience hurt if your insurance paid only $15,000 towards a $100,000 injury? You might feel better if you could offer substantially more financial help. The State requires you carry only $15,000 liability. But, maybe your feelings of morality dictate you carry more.

Return to application Do you still have questions? 949-831-3723 fax 949-496-8354






| Return to application |

UM (Uninsured/Underinsured Motorist)

Uninsured/Underinsured Motorist coverage pays for injuries, pain and suffering, and loss of earnings if you are in an accident with an uninsured or underinsured motorist, and it is their fault.

U.M. covers you and your passengers while you are in your car. It also covers you and the immediate members of your family no matter where you are-- in or out of your car.

For example, if you and your child are walking down the street and an uninsured motorist jumps the curb and hits you both, coverage is triggered.

$30,000/$60,000 U.M. coverage means the maximum pay-out is $30,000 per person, $60,000 per accident.

How much coverage do you need? If you and other members of your household are already covered by good health and disability insurance, you have less need for U.M. than a person with poor or no coverage. $30,000/$60,000 is common for people with good coverage.

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354






| Return to application |

Uninsured Motorist Collision Deductible Waiver (U.M.P.D.)

U.M.P.D. waives your deductible if the following three conditions are all met:

  1. You are involved in an accident with an uninsured motorist.
  2. The uninsured motorist is 100% at fault for the accident.
  3. The insurance company can verify the accident was 100% the fault of an uninsured motorist.

In short, U.M.P.D. can waive your deductible under some unusual circumstances. In my experience (Bob Heineman), only about one in five accidents meet all three of these criteria. For instance if you are hit by someone who is drunk, and uninsured, and there is a police report to verify these facts, your deductible will be waived. On the other hand, if the accident is even 1% your fault, the deductible will not be waived.

A similar coverage, called Uninsured Motorist Property Damage, is available for drivers who elect not to carry collision coverage. If you carry U.M.P.D. without collision and the above three criteria are met, the insurance company will fix your car. The maximum amount the insurance company will pay is $3,500 or the value of the car, which ever is less. The insurance company will pay you even though you do not carry collision coverage.

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354






| Return to application |

Medical Payments

Med. pay covers your injuries and your passenger's injuries if you are hurt in an accident no matter who is at fault. The coverage is a per person coverage, so if you have $5,000 medical pay and three people are hurt in your car, each person could potentially collect $5,000 to pay for their injuries.

To save money, many people elect not to carry medical payments on their auto policy, if already covered by a good medical plan.

If you reject medical payments, and you cause an accident, the liability (bodily injury ) portion of your policy can cover injured passengers, if your passengers are not members of your household or immediate family.

If you are in an accident that is not your fault and your unrelated passengers are injured, the other person's liability, or your uninsured motorist coverage will pay.

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354






| Return to application |

Comprehensive and Collision Deductibles

Comprehensive pays to fix your car if it is damaged by fire, vandalism or flying objects (stones hitting your windshield). Comp. also covers your car if it is stolen.

Collision fixes your car if you hit something, or if something hits you.

I (Bob Heineman) generally recommend minimum deductibles of $1,000 for comprehensive and collision. Sometimes even higher deductibles are warranted.

Why high deductibles? First, they save you money. Second, you should utilize car insurance only to cover catastrophic, major problems, not little claims. I do not recommend submitting claims less than $1,000 because your rate will usually go up after you place a claim-- offsetting any economic advantage you gained by placing the claim in the first place.

If your car is older and not worth much, you may wish to consider eliminating comp. and collision totally to save money.

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354






| Return to application |

Towing & Road Service

Towing and road service pays to have your car towed if it stops running. It also pays to get you started if your battery goes dead.

If you lock yourself out of your car, it pays for a locksmith to open your car.

Bob Heineman Brokerage offers one of the best towing and road services available-- there is no specific mileage limit the company will pay to have you towed. The only limit is you must have your car towed to the closest suitable repair shop that can fix your car.

For instance, if you are out in the middle of "tin-buck-too" when you break down, we will pay to have you towed 100 miles, if that is what it takes to get you to the nearest town. Many road service plans have a 5 to 25 mile tow limit.

How do you contact towing if you break down? Dial a free 800 number anywhere in the USA, and help will be on the way in short order.

You can use any convenient tow company, including AAA® authorized towers.

If you break down a couple blocks from a gas station, use the gas station's tow truck. When you return home, submit the bill to Bob Heineman Brokerage. He can usually issue a refund check on the spot.

One final advantage is cost-- usually only $9 per car per 6 months. The only disadvantage is we do not offer the nifty maps and travel services companies like AAA ® offer.

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354






| Return to application |

Car Rental

Car rental (also called collision plus) pays for a rental car if you are involved in an accident that exceeds your deductible. Typical reimbursement is $25 a day up to a maximum of $500 while your car is being fixed. Other options exist offering higher (or lower) per diems.

Car rental has an interesting feature called loss of use. Loss of use means you will be reimbursed $25 a day after an accident, even if you decide not to rent a car.

If you get into an accident and decide not to rent, you can pocket the $25 a day, or put it towards your deductible. Few other companies offer such a neat feature!

| Return to application | Do you still have questions? 949-831-3723 fax 949-496-8354