Skip to the content
Planning for Your Tomorrow Today
Call
(800) 366-3846
Request Quote
(opens in new tab)
Home Page (opens popup window)
Services
Personal Insurance
Auto Insurance
Boat & Marine Insurance
Condominium Insurance
Flood Insurance
High Net Worth Coverage
Homeowners Insurance
Motorcycle Insurance
Renters Insurance
- View All Personal
Business Insurance
Agriculture/Farm
Business Interruption Insurance
Business Owners Package Insurance
Commercial Auto Insurance
Commercial Property Insurance
Commercial Umbrella Insurance
General Liability Insurance
Hotel & Motel Hospitality Insurance
Professional Liability (E&O) Insurance
Surety Bonds
Workers’ Compensation Insurance
- View All Business
Life & Health Insurance
Individual & Family Health Insurance
- View All Life and Health
Financial Services
Annuities
Retirement Plans (401K, SEP, SIMPLE)
Traditional & Roth IRAs
Investment Advisory Services
Mutual Funds
Health Insurance
Life Insurance
- View all Financial Services
Employee Benefits
Group Disability Insurance
Group Life Insurance
Group Health Insurance
Group Dental Insurance
Group Long-Term Care (LTC) Insurance
Group Vision Insurance
Health Savings Accounts
- View All Group Benefits
Benefits Administration
(opens in new tab)
About Us
Our Team
LD&B Cares
Careers
Partnership Opportunities
Insurance Blog
Policy Service
Online Billing & Payments
File A Claim
Auto ID Card Request
Certificate of Insurance Request
Policy Change Request
Insurance Resources
Contact Us
Harrisonburg Office (Main Location)
Bridgewater Office
Broadway Office
Luray Office
Mt. Jackson Office
Staunton Office
Woodstock Office
Email Signup
Secure Contact Form
Refer a Friend
Home
>
Auto Insurance Quote
Auto Insurance Quote
Personal Information
Name
*
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
Current Insurance Information
Insurance Company Name (not agency):
Expiration:
Month
Day
Year
Years Insured:
Premium Paid:
Policy Term:
6 Months
1 Year
Vehicle Information
How many cars will be insured?
1
2
3
4
Vehicle 1 Information
Year
Make
Model
VIN
Deductibles
Comprehensive
$0
$100
$250
$500
$750
$1000
Collision
$0
$250
$500
$750
$1000
Other Options
Towing
Rental Reimbursement
Vehicle 2 Information
Year
Make
Model
VIN
Deductibles
Comprehensive
$0
$100
$250
$500
$750
$1000
Collision
$0
$250
$500
$750
$1000
Other Options
Towing
Rental Reimbursement
Vehicle 3 Information
Year
Make
Model
VIN
Deductibles
Comprehensive
$0
$100
$250
$500
$750
$1000
Collision
$0
$250
$500
$750
$1000
Other Options
Towing
Rental Reimbursement
Vehicle 4 Information
Year
Make
Model
VIN
Deductibles
Comprehensive
$0
$100
$250
$500
$750
$1000
Collision
$0
$250
$500
$750
$1000
Other Options
Towing
Rental Reimbursement
Liability Limit For ALL Cars
Choose Either:
Bodily Injury and Property Damage
Single Limit
Bodily Injury:
Select One
$10,000/$20,000
$25,000/$50,000
$50,000/$100,000
$100,000/$300,000
$250,000/$500,000
Property Damage:
Select One
$10,000
$25,000
$50,000
$100,000
$500,000
Single Limit:
Select One
$60,000
$100,000
$300,000
$500,000
Personal Injury Protection (PIP):
Select One
$15,000
$50,000
$75,000
$150,000
$250,000
Medical Payments Coverage Limits:
Select One
$500
$1,000
$2,000
$3,000
$4,000
$5,000
$10,000
PIP Deductibles:
Select One
$250
$500
$1,000
$2,000
$2,500
Driver Information
Number of Drivers:
1
2
3
Driver 1 Information
Name:
First
Last
Relationship:
Self
Spouse
Child
Other Relative
Not Related
Drivers License #:
State Issued:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
How Long Licensed?:
Date of Birth:
*
Month
Day
Year
Claims and Accidents in past 3 years - include date, amount paid, description)
Driver 2 Information
Name:
First
Last
Relationship:
Select One
Spouse
Child
Other Relative
Not Related
Drivers License #:
State Issued:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
How Long Licensed?:
Date of Birth:
*
Month
Day
Year
Claims and Accidents in past 3 years - include date, amount paid, description)
Driver 3 Information
Name:
First
Last
Relationship:
Select One
Spouse
Child
Other Relative
Not Related
Drivers License #:
State Issued:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
How Long Licensed?:
Date of Birth:
*
Month
Day
Year
Claims and Accidents in past 3 years - include date, amount paid, description)
Excess Liability
Amount:
$1 Million
$2 Million
$3 Million
$5 Million
$10 Million
Personal Umbrella Coverage:
Yes
No
Additional Comments or Questions
Phone
This field is for validation purposes and should be left unchanged.
Δ