call today for your insurance needs: 215.949.3700

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EZ Auto Tags & Notary
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About
Contact
Map
Get A Quote
EZ Auto Tags & Notary

Your Information

Online Automobile Insurance Quote Form

Please fill out ALL sections below and an agent will get back to you with a quote.

Your Information

Name:*

Full Address:*

Email*

Phone:*

Marital Status: (Single or Married)

Homeowner? (Yes or No)

Attach Picture of License

Attachments (0)

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Driver #1 Information

Name:*

Sex (M/F):

Email*

Birthdate (00/00/0000):*

# of Years U.S. Licensing:

Does Driver need an SR22 Filing (Yes or No):

If YES to SR22 filing, why? (list accident/cite)

Daily commute in ONE WAY miles:

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Driver #2 Information

Name:*

Sex (M/F):

Email*

Birthdate (00/00/0000):*

# of Years U.S. Licensing:

Does Driver need an SR22 Filing (Yes or No):

If YES to SR22 filing, why? (list accident/cite)

Daily commute in ONE WAY miles:

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vehicle #1 Information

Year (if 'Non-Owner', write here):

Vehicle ID# (for rating accuracy):

Email*

Annual Mileage:

Make & Model:

Used in business? (If yes, explain)

Uninsure Motorists Coverage? (Yes or No)

Rental Car & Towing Coverage? (Yes or No)

Medical and/or PIP Coverage? (Yes or No)

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vehicle #2 Information

Year (if 'Non-Owner', write here):

Vehicle ID# (for rating accuracy):

Email*

Annual Mileage:

Make & Model:

Used in business? (If yes, explain)

Uninsure Motorists Coverage? (Yes or No)

Rental Car & Towing Coverage? (Yes or No)

Medical and/or PIP Coverage? (Yes or No)

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Privacy Policy

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By filling out these forms you agree to allow our agency to release this information via the email/phone you provided and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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sterling insurance agency

Mailing Address: Sterling Auto Ins. 6908 Bristol-Emilie Road Baily's Plaza, Levittown, PA, 19057

(215) 949-3700

PA Insurance License #: 55812