Vincent F. Gauci - VFG Associates,LLC

VFG Associates, LLC

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Call 734-855-4930
or 800-859-4453
Fax 734-855-4933
29432 Joy Road, Livonia, MI 4815

Request Form

Personal Auto Quote Request

Please remember: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.

Please Select your preferred agent.
Agent:
Effective Date:  
Your Name:  
Your Mailing Address: Street   E-mail Address:
    Daytime Phone:
  City, State & Zip  
       
Prior Address:
(If less than 2yrs at current address)
Street   Choose One:   Please call me with quote premium.
      Please send quote via e-mail.
  City, State & Zip      
            
Current coverage: Company:
 
 Expiration Date:
 Liability Limits:
Liability Limits and Coverages: Please select the coverages and limits that are to apply to your vehicles.
Bodily Injury
Property Damage
Medical Payments
Uninsured Motorists


Uninsured Motorists Property Damage
Enter additional information/comments here:
Your Vehicles:   If you have more than four vehicles, please call our office for a quote.
Vehicle 1. Vehicle 2.
Year:
Make and model: VIN (if known):
Year:
Make and model: VIN (if known):
Vehicle Use
Miles to work/school
Vehicle Use
Miles to work/school
Comprehensive
Collision
Comprehensive
Collision
Optional Coverages:
 
Towing and Labor
 Rental Reimbursement
 Loan Lease Gap
Optional Coverages:
 Towing and Labor
 Rental Reimbursement
 Loan Lease Gap
 
Vehicle 3. Vehicle 4.
Year:
Make and model: VIN (if known):
Year:
Make and model: VIN (if known):
Vehicle Use
Miles to work/school
Vehicle Use
Miles to work/school
Comprehensive
Collision
Comprehensive
Collision
Optional Coverages:
 Towing and Labor
 Rental Reimbursement
 Loan Lease Gap
Optional Coverages:
 Towing and Labor
 Rental Reimbursement
 Loan Lease Gap
Driver Information:   If there are more than four drivers, please call our office for a quote.
Driver 1: Driver 2:
Name:
DOB:
 Sex:
Name:
DOB:
 Sex:
Occupation:
Marital Status:
  Occupation:
Marital Status:
 
 Good Student Discount (3.0 ave. or better)  Good Student Discount (3.0 ave. or better)
 At School over 100 miles away  At School over 100 miles away.
Accidents or violations (including not-at-fault) in the past 3 years:

Accidents or violations (including not-at-fault) in the past 3 years:
   
Driver 3: Driver 4:
Name:
DOB:
 Sex:
Name:
DOB:
 Sex:
Occupation:
Marital Status:
  Occupation:
Marital Status:
 
 Good Student Discount (3.0 ave. or better)  Good Student Discount (3.0 ave. or better)
 At School over 100 miles away.  At School over 100 miles away.
Accidents or violations (including not-at-fault) in the past 3 years:


Accidents or violations (including not-at-fault) in the past 3 years:
Household Members: (Non-Drivers)
Name:
D.O.B.
Relationship:
Drivers License #:
Insurance Carrier:
Policy Number:
Comments:
Please use the box below to enter any additional information you feel should be considered:

Protecting your privacy and identity is very important to us. 
Your Social Security and drivers license number may be required to complete this quote.   Please be sure you have provided an accurate contact number so that we can contact you personally for this information.

If you have not received a response from us within one business day, please contact us again.


Securities Offered Through KCD Financial,Inc. Member FINRA & SIPC, 3313 S. Packerland Drive, Suite E, DePere, WI 54115