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- Existing Coverage
Do you currently have auto insurance?
Please upload a copy of your existing auto policy
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
We just need to know a little bit about you so we can contact you with your quote once you've completed the form.
How do you prefer we contact you with your quote?
Full Names and dates of birth of ALL drivers on the policy
License numbers of all drivers
Did any driver have their license in another state or country previously?
Please list the driver, state or country, and date first licensed:
Please upload a photo of your out of state/country drivers license and or driving record:
Having this information allows us to give you credit for your out of state driving experience which will give you the most competitive rate.
Drop files here or
Max. file size: 100 MB.
Vehicle Identification Numbers (VIN) of all cars, if available
What address will the car(s) be parked?
What would you like your deductible to be?
Will you need....
Rental Car Coverage
Towing and Labor Coverage
Do you have AAA?
Please enter your AAA membership number if you have it available, as well as your AAA member since date:
Does anyone on your policy drive any vehicle for a ride sharing network?
(Uber, Lyft, Doordash, Etc.)
Please list the name of the person who referred you to Berlin Insurance Group:
If you were referred to a specific sales representative, please list their name here:
Any additional notes, questions, or concerns?
This field is for validation purposes and should be left unchanged.
CONTACT US ANYTIME