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This quotation will be an estimate with the most common coverage amounts.
* is required fields
Requestor Information
Full name*:
  
Address*:
  
City*:
  
Zip*:
  
E-Mail*:
  
Phone*:
  
Fax:
Return quote via*:
 E-Mail Fax Phone

Automobile Information
Vehicle #1
Year*:
  
Make*:
  
Model*:
  
VIN #:
Annual Mileage:
Purpose*:
Garage*:
Doors*:
 2 Dr 4 Dr
Primary driver*:
  
Vehicle #2
Year:
Make:
Model:
VIN #:
Annual Mileage:
Purpose:
Garage:
Doors:
 2 Dr 4 Dr
Primary driver:

Driver Information
How many drivers?*
 1 2
Driver #1
How many accidents?*
Accident: Collision with another vehicle or object. Enter the number of collisions that you were found to be at fault within the last three years.
How many minor violations?*
Minor moving violations include offenses such as speeding, illegal turns and failure to make a complete stop. Enter the number of minor violations occurring within the last three years.
How many major violations?*
Major moving violations include offenses such as DUI, reckless driving, or a hit and run. Enter the number of major violations occurring within the last three years.
Driver #2
How many accidents?
How many minor violations?
How many major violations?
Current Information
Insurance Company:
Policy Expiration Date:
Current Premium:
$ Annual Semi-Annual
Liability Coverages
Bodily Injury*:
Hawaii Law requires bodily injury liability coverage of not less than the basic limits of $20,000 per person/$40,000 per accident. Bodily injury liability coverage pays the amount, up to the limit of coverage, which you are legally responsible to pay for injuries to others caused by a motor vehicle accident.
Property Damage*:
Hawaii Law requires property damage liability coverage of not less than the basic limit of $10,000. Property damage liability coverage pays the amount, up to the limit of coverage, which you become legally responsible to pay for damage to property of others caused by a motor vehicle accident.
Personal Injury Protection (PIP)*:
Hawaii Law requires Personal Injury Protection (PIP) coverage of not less than the minimum limit of $10,000 per person. PIP pays the amount, up to the limit of coverage, for medical expenses you may incur as a result of a motor vehicle accident.
PIP Deductible*:
You may select a deductible that will enable you to reduce your PIP premium. In the event of an accident, you will be responsible for the payment of the deductible amount.
Uninsured Motorist*:
 Accept Decline
This coverage pays for bodily injury damages the insured would be legally entitled to recover from the operator of an uninsured auto caused by an accident arising out of the ownership, maintenance, or use of the vehicle. An uninsured vehicle is one that has no liability coverage. This coverage is mandatory unless reduced or rejected in writing. It will be added at the same limits as your Bodily Injury coverage.
Underinsured Motorist*:
 Accept Decline
This coverage fills in the gaps that may exist between an underinsured motorist's bodily injury insurance limit and the damages for bodily injury the insured is legally entitled to, if greater. This coverage pays an insured who suffers bodily injury when struck by an at-fault driver who has some but not enough liability coverage to pay damages. This coverage is mandatory unless reduced or rejected in writing. It will be added at the same limits as your Bodily Injury coverage.
Pysical Damage Coverages
Vehicle #1
Comprehensive*:
This provides coverage for any direct and accidental damage to the vehicle other than collision. Comprehensive coverage is essentially all-risk and includes damage caused by theft, fire, vandalism, flood, and many more. This quote will include a $250 deductible which can be adjusted to better suit your needs.
Collision*:
This coverage pays for direct accidental loss due to upset or collision of the vehicle with another object. Collision coverage would provide protection for and insured auto due to a collision with another vehicle, collision with another object, and upset or overturn of the vehicle. This quote will include a $250 deductible which can be adjusted to better suit your needs.
Towing*:
This pays the towing costs and labor performed at the place or scene of disablement. Any labor must be performed at the scene of disablement and any cost of replacement materials is not covered.
Vehicle #2
Comprehensive*:
Collision*:
Towing*:




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