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Online Automobile
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Personal Data
Your Name:
Street Address:
City:
State: MUST be Connecticut!
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Marital Status:
Single Married
 Homeowner?
Yes No
 
Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)

DRIVER INFORMATION #1
Name: Birthdate:
Sex (M/F): # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Daily commute
in ONE WAY miles:
Does Driver need
an SR22 FILING?		 Yes No If YES to SR22 filing, why needed?
(list accident/cite)

DRIVER INFORMATION #2 (if none, leave blank)
Name: Birthdate:
Sex: # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Daily commute
in ONE WAY miles:
Does Driver need
an SR22 FILING?		 Yes No Comments or
Remarks?
If More than 2 Drivers, list Additional Driver's Names, Birthdates, and driving record history here:

VEHICLE #1 INFORMATION
(if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
Year of vehicle: Make & Model:
Vehicle ID# (for rating accuracy):
Annual Mileage: Used in business?
(Explain, if yes):
VEHICLE #1 COVERAGES:
Select Liability Limits
 
Select Comprehensive Deductible:
 
Select Collision Deductible:
 
Uninsured Motorists
Coverage?		 YES NO
 
Rental Car &
Towing Coverage?		 YES NO
 
Medical and/or
PIP Coverage?		 YES NO
 
 
VEHICLE #2 INFORMATION (if none, leave blank)
Year of vehicle: Make & Model:
Vehicle ID# (for rating accuracy):
Annual Mileage: Used in business?
(Explain, if yes):
VEHICLE #2 COVERAGES:
Select Liability Limits - - - Liability Limits Must
Match Vehicle #1 - - -
 
Select Comprehensive Deductible:
 
Select Collision Deductible:
 
Uninsured Motorists
Coverage?		 YES NO
 
Rental Car &
Towing Coverage?		 YES NO
 
Medical and/or
PIP Coverage?		 YES NO
 
Comments or Remarks:
(List additional drivers, autos, etc. here)
If More than 2 Vehicles or Drivers, list Additional Vehicles Year, Makes, and Models, and Driver's Ages and Driving records here:

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More About The Adinolfi Group, Inc.
Agency Owner, Advisor Rich Adinolfi Agency Owner, Advisor
Rich Adinolfi

Thanks for visiting! I'm Rich Adinolfi, Agency Owner of The Adinolfi Agency. We have been providing Connecticut residents with quality customer service for more than 20 years and want the chance to show you our outstanding online service and pricing!

We would like to speak with you personally about your Connecticut insurance needs. Please phone me, M-F 9am - 5:30pm (EST), or if you prefer, request quotes online using our convenient website forms. We promise to be responsive and informative, whether by phone or online. My staff and I look forward to serving you.


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Our agency specializes in your commercial vehicle insurance. Whether you have a car you use in business, or a contractor using your truck in your operations, we can help.

Get a FAST & FREE Online Commercial Vehicle quote today.


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