New Jersey Car Insurance Quote

In addition to New Jersey
Car Insurance, we also offer
affordable Home Insurance
policy premiums or choose
another NJ family insurance
coverage from the list below.

**Information received from this New Jersey Car Insurance quote

request form sent to American Insurance Services Agency will be for our use only

and will not be sold, given to or distributed to any other parties. A quote will be based

on the car insurance policy information provided and does not guarantee

acceptance of the risk by us. The precise coverage afforded is subject to meeting

underwriting guidelines, and the terms, conditions and exclusions of the policy as

issued. By submitting this request you acknowledge that this is neither an offer to

insure nor a guarantee of insurance. Completion of this form does not entitle you

to a New Jersey Auto Insurance Policy. We are licensed in New Jersey and

will not provide quotes for other states.

"Your Local New Jersey Car Insurance Policy Agent!"

We offer affordable New Jersey car insurance policy premiums to residents of the

following NJ counties and cities: Union County, Essex County, Bergen

County, Passaic County, Sussex County, Morris County, Warren County,

Hunterdon County, Somerset County, Middlesex County, Monmouth County,

Mercer County, Burlington County, Clark, Newark, Jersey City, Elizabeth, Rahway,

Colonia, Iselin, Avenel, Woodbridge, Port Reading, Carteret, Perth Amboy, Fords,

South Amboy, Metuchen, Plainfield, Dunellen, South Plainfield, Green Brook,

Fanwood, North Plainfield, Cranford, Scotch Plains, Westfield, Union, Millburn,

Springfield, Mountainside, Gillette, Warren, Watchung, Stirling, Millington,

Middlesex, Martinsville, Piscataway, Edison, New Brunswick, Highland Park, North

Brunswick, Sayreville, East Brunswick, Somerset, Milltown, South River, Bound

Brook, Somerville, Bridgewater, Bayonne, Linden, Roselle, Hoboken, Union City,

Weehawken, West New York, Guttenberg, Cliffside Park, Edgewater, North Bergen,

Secaucus, Fairview, Ridgefield, Fort Lee, Leonia, Palisades Park, Englewood Cliffs,

Englewood, Bergenfield, Teaneck, Paramus, Bogota, Ridgefield Park, Little Ferry,

Hackensack, Maywood, Teterboro, South Hackensack, Rochelle Park, Moonache,

Lodi, Hasbrouck Heights, Saddle Brook, Garfield, Elmwood Park, Woodridge,

Carlstadt, East Rutherford, Lyndhurst, Rutherford, Wallington, Passaic, Clifton,

Paterson, Totowa, West Paterson, Little Falls, Great Notch, North Caldwell, Cedar

Grove, Verona, Montclair, Bloomfield, West Orange, Glen Ridge, Belleville, Nutley,

Kingsland, North Arlington, Kearney, Harrison, East Orange, East Newark, Orange,

Irvington, South Orange, Hillside, Townley, Livingston, Wayne, Trenton, Camden,

Atlantic City, Princeton, Vineland, Willingboro, and Toms River, NJ.

New Jersey Car Insurance Coverage Information

Applicant Information

Car Insurance Coverage Information:

New Jersey Driver Information:

Full Name:
Home Address:
City:     State:     Zip Code:
Email Address: (Required)
Home Phone: Work Phone: Ext.
How to Contact You:
Date of Birth:             (mm/dd/yyyy)
Gender:         Marital Status:
Do you own or rent your home.   (Required Information)

Vehicle     Year           Make                Model                 Body Type
     1
     2
     3

Vehicle     Primary Use     Miles Driven to Work       Cost New
     1                         $
     2                         $
     3                         $

What type of air bag system is your car equipped with?
Vehicle
     1
     2
     3

What type of anti-lock brake system is your car equipped with?
Vehicle
     1
     2
     3

Do you have a car alarm?
Vehicle
     1
     2
     3

                      Liability                   Uninsured                                             Collision         Comprehensive
Vehicle    Limits(x $1,000)      Motorist(x $1,000)       Medical              Deductible           Deductible
     1
     2
     3

                                  Drivers                          Date of                                              Drivers
Driver                       Name                               Birth                  Gender                 License #
     1
     2
     3

Is your driving record accident & violation free during the past 5 years?
Driver
     1       If No, how many accidents?    How many violations?
     2       If No, how many accidents?    How many violations?
     3       If No, how many accidents?    How many violations?

Was your driver's license suspended during the past 5 years?
Driver
     1
     2
     3

Current Insurance Company:
Expiration Date: (mm/dd/yyyy)

Additional Information or Comments

Click on the "Submit Quote Information" button below to send
your New Jersey Car insurance quote request.**