* Required fields
E-mail Address *
Date of Birth
Street Address *
Postal Zip Code *
What County do you live in?
Phone Number *
Preferred Start Date of Policy
Is your Collector Car registered to the above Address? *
Do you have Historic or Regular Plates
Historic Plates Regular Plates
Who is your Current Collector Auto Company?
Not Insured New Purchase Hagerty / One Beacon Grundy JC Taylor American Modern American Collectors Condon & Skelly Elite Collector Car Heacock Classic Auto Leland West Sneed Chrome Other
Number of Licensed Drivers in the Home?
1 2 3 4 5 6 7 8
How many Daily use Vehicles in the home?
1 2 3 4 5 6 7 8
Does any operator to be insured have two or more violations or a D.U.I. within the last five years? *
Are any operators of collector vehicles to be insured under 25 years old? *
What are the Current limits for your Daily Driver Auto Policy for Bodily Injury? *
$ 50,000 $ 100,000 $ 300,000 $ 500,000
What are your Daily Driver Policy Uninsured/Underinsured Limits?
None $50,000 $100,000 $300,000 $500,000
Year, Make, Model *
Agreed Value *
Expected Annual Mileage (once a week use averages to 1500 miles per year) *
Does the Vehicle have an Alarm?
None Active Alarm (must be mannually set) Passive Alarm (does not need to be manually set) Locator System
Is your Collector Car kept in the Garage?
Garage Type *
Attached Enclosed Garage Attached Enclosed Garage with Monitored Alarm Detached Enclosed Garage Carport Pole Barn Locked Trailer Secured Indoor Storage Other
Does your new Collector Car have a GPS Tracker?
Do you belong to any Automobile Clubs? Good Guy's, NSRA, Camaro Worldwide, etc, etc.
Are there any Veterans, Active Duty, or Retired Military members in the home?