Tell us about your current coverage Please complete all fields to the best of your knowledge. Do you currently have auto insurance coverage? YES NO Who is your current insurer? ---Alphabetical Listing of all Insurance Companies--- AAA Insurance Co. AETNA AFLAC AIG AIU Insurance Allied Allstate County Mutual Allstate Indemnity Allstate Insurance American Alliance Insurance American Automobile Insurance American Casualty American Deposit Insurance American Direct Business Insurance American Empire Insurance American Family Insurance American Family Mutual American Financial American Home Assurance American Insurance American International Ins American International Pacific American International South American Manufacturers American Mayflower Insurance American Motorists Insurance American National Insurance American Premier Insurance American Protection Insurance American Republic American Savers Plan American Service Insurance American Skyline Insurance Company American Spirit Insurance American Standard Insurance - OH American Standard Insurance - WI Amica Insurance Arbella Associated Indemnity Assurant Atlanta Casualty Atlantic Indemnity Auto Club Insurance Company Blue Cross and Blue Shield Cal Farm Insurance California State Automobile Association Chubb Clarendon American Insurance Clarendon National Insurance CNA Colonial Insurance Company Not Listed Continental Casualty Continental Divide Insurance Continental Insurance Cotton States Insurance Country Insurance and Financial Services Dairyland County Mutual Co of TX Dairyland Insurance Electric Insurance Erie Insurance Company Erie Insurance Exchange Erie Insurance Group Erie Insurance Property and Casualty Esurance Farm Bureau/Farm Family/Rural Farmers Insurance Farmers Insurance Exchange Farmers TX County Mutual Farmers Union Fire and Casualty Insurance Co of CT Fireman's Fund Geico Casualty Geico General Insurance Geico Indemnity GMAC Insurance Golden Rule Insurance Government Employees Insurance Guaranty National Insurance Hanover Lloyd's Insurance Company Hartford Accident and Indemnity Hartford Casualty Insurance Hartford Fire Insurance Hartford Insurance Co of Illinois Hartford Insurance Co of the Southeast Hartford Omni Hartford Underwriters Insurance Health Plus of America HealthShare American Humana IFA Auto Insurance IGF Insurance Infinity Insurance Infinity National Insurance Infinity Select Insurance Integon John Hancock Kaiser Permanente Kemper Lloyds Insurance Landmark American Insurance Leader National Insurance Leader Preferred Insurance Leader Specialty Insurance Liberty Insurance Corp Liberty Mutual Fire Insurance Liberty Mutual Insurance Liberty National Liberty Northwest Insurance Lumbermens Mutual Maryland Casualty Mass Mutual Mega/Midwest Mercury Metropolitan Insurance Co. Mid Century Insurance Mid-Continent Casualty Middlesex Insurance Midland National Life Mutual of New York Mutual Of Omaha National Ben Franklin Insurance National Casualty National Continental Insurance National Fire Insurance Company of Hartford National Health Insurance National Indemnity National Union Fire Insurance of LA National Union Fire Insurance of PA Nationwide General Insurance Nationwide Mutual Fire Insurance Nationwide Mutual Insurance Nationwide Property and Casualty New York Life Insurance Northwestern Mutual Life Northwestern Pacific Indemnity Omni Indemnity Omni Insurance Orion Insurance Pacific Indemnity Pacific Insurance Pafco General Insurance Patriot General Insurance Peak Property and Casualty Insurance PEMCO Insurance Progressive Progressive Auto Pro Prudential Insurance Co. Reliance Insurance Reliance National Indemnity Reliance National Insurance Republic Indemnity Response Insurance SAFECO Safeway Insurance Safeway Insurance Co of AL Safeway Insurance Co of GA Safeway Insurance Co of LA Security Insurance Co of Hartford Security National Insurance Co of FL Sentinel Insurance Sentry Insurance a Mutual Company Sentry Insurance Group Shelter Insurance Co. St. Paul St. Paul Fire and Marine St. Paul Insurance Standard Fire Insurance Company State and County Mutual Fire Insurance State Farm County State Farm Fire and Cas State Farm General State Farm Indemnity State Farm Insurance Co. State Farm Lloyds Tx State Farm Mutual Auto State National Insurance Superior American Insurance Superior Guaranty Insurance Superior Insurance The Ahbe Group TICO Insurance TIG Countrywide Insurance Travelers Indemnity Travelers Insurance Company Tri-State Consumer Insurance Twin City Fire Insurance UniCare United Pacific Insurance United Security United Services Automobile Association Unitrin Direct Universal Underwriters Insurance US Financial USAA USF and G Viking County Mutual Insurance Viking Insurance Co of WI Windsor Insurance Woodlands Financial Group Zurich North America Company Not Listed Policy Expiry Date: Month 01 02 03 04 05 06 07 08 09 10 11 12 Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 How many years have you been insured with your current company? 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years More than 10 years How many years have you been continuously insured? 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years More than 10 years

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