Massachusetts Auto Insurance Reform Update

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Automobile Insurance Update

Let Markham Priest Insurance help you maximize your savings with auto insurance.

In 2008, the State of Massachusetts is allowing auto insurance carriers to establish their own competitive premiums. Consumers have ample opportunity to reduce their insurance costs and select enhanced coverages such as accident forgiveness, diminishing deductible and new vehicle replacement cost to name a few. Markham Priest Insurance represents 75% of the auto carriers available to independent agents in the State of Massachusetts. We can provide premium flexibility and numerous carrier choices to you.

Please take a few moments to complete this questionnaire. It will help us determine which coverage plan and carrier is best for you.

Please Note: Submitting this form does not bind coverage

Fill in the form below with as much of your information as possible.
Field marked with an '*' are required.


General Information:
Owner's First Name:*
Middle:
Last:*
Address:*
City:*
State:*
Zip:*
Date of Birth:*		(mm/dd/yyyy)
Home Phone #:*
Cell Phone #:
Email:*
Do you currently have life insurance?		Yes No If yes, how much?
Do you currently have health insurance?		Yes No
Do you currently have a home-based business or do you currently own a business?		Yes No
Answer the following questions to maximize your discounts for auto insurance:
How many years have you been with your current carrier?
Are any of your autos eligible for a low mileage discount? (less than 7500 or 5000 miles)		Yes No
Are you a teaching professional or employee of a school system?		Yes No
Have you taken a certified driver training course and do you have a certificate?		Yes No
Does your student driver maintain a B average or better?		Yes No
Do you have any children in college and where do they go to school?
Do you drive a hybrid vehicle?		Yes No
Are you a public transit user? (i.e. Charlie Card Holder)		Yes No
Are you a member of AAA Motor Club?		Yes No
Do you have a Savings Bank Life Insurance (SBLI) Policy?		Yes No
Please check the following features that are most important to you:
Accident Forgiveness		Additional Towing and Labor
Diminishing Deductible		Emergency Roadside Assistance
Expanded Rental		Identity Theft Resolution
New Vehicle Replacement Cost		OEM Parts Coverage
Lease/Loan Gap Coverage		Personal Clothing Coverage
Travel Expense Coverage		Trip Interruption Coverage

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Markham Priest Insurance • 20 Central Ave. • P.O. Box 310 • Ayer, MA 01432
Phone: 1-800-971-0800 • Fax: 978-772-9506
Office Hours • Monday - Friday: 8:00 am - 5:00 pm or By Appointment
To learn more about Markham Priest Insurance, please download our company brochure.