Auto Quote Questions | Bailey Place Insurance in Cortland, New York

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607-756-2805
2 N. Main Street
Cortland, NY 13045
607-844-8626
78 North Street
Dryden, NY 13053
607-319-0094
2428 N. Triphammer Rd
Ithaca, NY 14850

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Auto Quote Questions

Bailey Place Insurance

Please fill out the information below.

Personal Information

Your name ✶

Are you the policy holder? ✶

Yes No

Relationship to policy holder ✶

Address include city, state, & ZIP ✶

E-mail ✶

Phone ✶

Checklist

Do you have current insurance? ✶

Yes No

Through what company and when does your current policy expire? ✶

What are your current liability limits? ✶

What are the vehicle(s) you would like to insure? (Year, make, model, and VIN for each vehicle) ✶

Do you own any other vehicles other than what you’ve listed above? ✶

Who are the vehicles registered to? ✶

Who are the vehicles titled to? ✶

Are any vehicles titled in a trust, partnership, corporation, or owned by two resident relatives other than husband and wife? ✶

Yes No

Do any of your vehicles have a loan on them? ✶

Yes No

Through what financial institution? ✶

Do you have a vehicle provided for your use through your employer or on a long-term lease? ✶

Yes No

Please explain ✶

Do you use any vehicle for any delivery or livery purposes? (Newspapers, Food, Uber, Lyft, GrubHub, Walmart, Instacart, etc.) ✶

Yes No

Do you use any vehicle for business purposes or in the course of your employment? ✶

Yes No

Do you use your vehicle to commute to work? ✶

Yes No

How many miles one way? ✶

How many miles do you drive each year? ✶

Do you use any of your vehicles to snowplow for others? (neighbors, businesses, friends, etc.)

Yes No

Names of all drivers in the household (even if they do not drive your vehicles)
Please list all driver names exactly as they appear on their driver's license. This is very important to get an accurate quote ✶

Dates of birth for all drivers in the household ✶

License numbers for all drivers in the household ✶

Has any driver been in any accident or received any tickets in the last 5 years? ✶

Yes No

Please explain in detail ✶

Have you or any household driver taken the NYS Defensive Driver course within the last 3 years? ✶

Yes No

Do you want comprehensive and collision coverage on any vehicle(s)? ✶

Yes No

What are your current coverage deductibles?

Do you want to carry Rental Reimbursement coverage on any vehicle? ✶

Yes No

Do you have AAA for your vehicles? ✶

Yes No

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About Us

Bailey Place Insurance is an independent insurance agency with offices in Cortland, Dryden, and Ithaca, New York.

Give us a call or request a quote online to find out how much we can save you on your insurance.

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Cortland Office

2 N. Main Street
Cortland, NY 13045

607-756-2805

Dryden Office

78 North Street
Dryden, NY 13053

607-844-8626

Ithaca Office

2428 N. Triphammer Rd
Ithaca, NY 14850

607-319-0094

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