Single Vehicle Auto Quote Form

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

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 vehicle as we may be able to retrieve the Vehicle Identification Number(VIN). If you have never insured your vehicle or if the vehicle is a newly purchased, please provide the VIN number 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)

Primary Phone Number(Required)

E-Mail Address(Required)

Current Insurance Provider

Time with current auto carrier

License (State, Number)

Name and approximate date of any moving or non-moving violations the past 3 to 5 years

List and date any at-fault or non-fault accidents, or Comprehensive claims last 5 years

Driver 2

Optional — complete only if there is a second driver to be added.

Driver 2: License (State, Number)

Driver 2: Name and approximate date of any moving or non-moving violations the past 3 to 5 years

Driver 2: List and date any at-fault or non-fault accidents, or Comprehensive claims last 5 years

Driver 3

Optional — complete only if there is a third driver to be added.

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.

First Name(Required)

What type of insurance are you looking for?

Single Vehicle Proposal

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

Driver 1 (Primary)

Driver 2

Driver 3

Important Notice

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