We do understand,
it matters...

When it matters.
TLC Insurance Agency, Inc.
Automobile Insurance PROPOSAL Form
It only takes a few minutes!
Referred By:
Choose the TLC Insurance location
nearest you: (Required)

Your Personal Data
First & Last Name: (Required)
Street Address:
City:
State:
Zip Code:
E-Mail (required):
E-Mail (re enter):
Phone:
Fax:
Marital Status:
Home Owner?:
Currently Insured?:
If yes, list carrier, and
expiration date.
Number of Household Members:
Does your medical provider
exclude auto accidents? :
Tickets or Accidents for Any Household
Member in Last 5 Years:
When And What For?

DRIVER INFORMATION #1
Name: Birthdate:
Sex: # Years U.S.
Licensing:
Daily commute in
in ONE WAY miles:
Comments or 
Remarks?:

DRIVER INFORMATION #2
Name: Birthdate:
Sex: # Years U.S.
Licensing:
Daily commute
in ONE WAY miles:
Comments or
Remarks?:
If More than 2 Drivers, List
Additional Drivers' Names,
Birthdates, and driving record
history here:

VEHICLE #1 INFORMATION
(if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
Vehicle ID# for rating accuracy:
Year of vehicle: Make & Model:
Vehicle Titled in Your Name: Annual Mileage:
Used in Business: If YES explain:
VEHICLE #1 COVERAGES
Select Liability Limits:
Select Property Damage Limits:
Select Comprehensive
Deductible:
Select Collision
Deductible:
Uninsured/Underinsured
Motorists Coverage:
Rental Car Coverage:
Towing Coverage:

VEHICLE #2 INFORMATION
(if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
Vehicle ID# for rating accuracy:
Year of vehicle: Make & Model:
Vehicle Titled in Your Name: Annual Mileage:
Used in Business: If YES explain:
VEHICLE #2 COVERAGES
Select Liability Limits:
Select Property Damage Limits:
Select Comprehensive
Deductible:
Select Collision
Deductible:
Uninsured/Underinsured
Motorists Coverage:
Rental Car Coverage:
Towing Coverage:
If More than 2 Vehicles, List
Additional Vehicles' Years,
Makes, and Models
here:

Comments or Questions:
Send my Auto Proposal by:
We treat all your responses as private information. We will not give your data to any other person or group for any purpose. Although it is our intent to keep your information private, we cannot guarantee that it will not be viewed by others accidentally. Our online quote forms are to provide current and prospective clients an estimated premium only. No coverage can be bound by this process until original applications, signatures and premium are received and submitted to the insurance company for underwriting.

If you agree, please select YES and click the Submit button so that we can get to work on getting you your quote.
I agree, send my proposal! (Required)

Would you like someone from
our agency to contact you?
Additional contact information
Paperwork for online transactions should reach you via mail in the next 5 to 7 days. If you don't receive your paperwork within this time frame, call us at (877) 852 4678.

Please, only click once.
Insurance Proposals
Two convenient locations to serve you: Sandusky, Caro.
Covering the Greater Thumbe Area Since 1934
We do understand, it matters...When it matters.