Multi-Vehicle Auto Quote Form

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12 Times represents many insurance that ask a variety of questions to help you get a better insurance rate. Please use Additional Information to provide more information if needed. If you have current auto insurance you only need to tell us the year, make, and model of your vehicles as we may be able to retrieve the Vehicle Identification Numbers(VINs). If you have never insured your vehicles or if the vehicles are newly purchased, please provide the VIN numbers if possible. We always try to respond promptly the same day or on the next business day. Thank you for giving 12 Times Better Insurance Plus an opportunity to earn your business.

How did you hear about 12 Times?(Required)

Personal Information

Garaging full address

Mailing address (if different)

Primary Phone Number

Alternate Phone Number

E-Mail Address(Required)

Relationship(Required)

How long have you been Continuously Insured?

Current Liability Limits

Approximate time & name of any major, minor or non-moving violations last 5 years

List at-fault, non-fault & Comprehensive claims last 5 years

Spouse Information

If yes, list name and approximate time for any major, minor, non-moving violations last 5 years

List any at-fault, non-fault accidents or Comprehensive claims last 5 years (Spouse)

Driver 2

Driver 2: Full name and middle initial

Driver 2: Relationship(Required)

Driver 2: Approximate time & name of any major, minor or non-moving violations last 5 years

Driver 2: List at-fault, non-fault & Comprehensive claims last 5 years

Driver 3

Driver 3: Full name and middle initial

Driver 3: Relationship(Required)

Vehicle 5: Collision Deductible

Vehicle 5: Comprehensive Deductible

Additional Vehicle Questions

Is any vehicle a Lease?

Any vehicle have a tow hitch & what is towed?

Additional Information

Important Notice

Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent or your insurance company.

Per the terms of our online privacy policy we will not resell your information to any third-party.

Multi-Vehicle Proposal

Posting or sending unsolicited content including promotional links or advertisements is prohibited.

Personal Information

Spouse Information

Driver 2

Driver 3

Driver 4

Driver 5

Vehicle #1

Vehicle #2

Vehicle #3

Vehicle #4

Vehicle #5

Additional Vehicle Questions

Important Notice

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