Teen Driver Insurance - Wadsworth, OH


Patrick O'Neill, CIC Certified Insurance Counselor Family Protection Specialist The O'Neill Group Call Today! 1.800.334.1561

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How Your Teen Can Become a Safer Driver

Are You Protected in Case Your Teen Causes a Serious Accident?

Do You Know if Your Teen is Driving Safely - ALL The Time?

Why You Should Get a 21 Point Protection Review

Are You Paying Too Much For Your Teen's Car Insurance?

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Police Officer James Poer's "Parental Courage" Blog
As a 30 year police accident investigator and father of 4 teen drivers, his advice can save your child's life!
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Auto Insurance Proposal Form

On-Line Automobile Insurance Proposal Form One Simple Form - takes only 2-3 Minutes! YOUR PERSONAL DATA
Your Name (required):
Street Address:
City:
State:
Zip Code:
E-Mail: (required)
Phone: (required)
Fax:

Marital Status: Single Married	Homeowner? Yes No

Currently Insured? (If yes, list carrier, and # of years continuous. If none, type N/C)

DRIVER INFORMATION #1
Name:		Birthdate:
Sex (M/F):		# Years U.S. Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years:		Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years:		Daily commute in ONE WAY miles:
Does Driver need an SR22 FILING?	Yes No	If YES to SR22 filing, why needed? (Only in applicable states) (list accident/cite)

DRIVER INFORMATION #2 (if none, leave blank)
Name:		Birthdate:
Sex (M/F):		# Years U.S. Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years:		Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years:		Daily commute in ONE WAY miles:
If YES to SR22 filing, why needed? (Only in applicable states) (list accident/cite)	Yes No	Comments or Remarks?

DRIVER INFORMATION #3 (if none, leave blank)
Name:		Birthdate:
Sex (M/F):		# Years U.S. Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years:		Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years:		Daily commute in ONE WAY miles:
If YES to SR22 filing, why needed? (Only in applicable states) (list accident/cite)	Yes No	Comments or Remarks?

DRIVER INFORMATION #4 (if none, leave blank)
Name:		Birthdate:
Sex (M/F):		# Years U.S. Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years:		Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years:		Daily commute in ONE WAY miles:
If YES to SR22 filing, why needed? (Only in applicable states) (list accident/cite)	Yes No	Comments or Remarks?

VEHICLE #1 INFORMATION (if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
Year of vehicle:		Make & Model:
Vehicle ID# (for rating accuracy):
Annual Mileage:		Used in business? (Explain, if yes):

VEHICLE #1 COVERAGES:
Select Liability Limits:

Select Comprehensive Deductible:

Select Collision Deductible:

Uninsured Motorists Coverage?	YES NO

Rental Car & Towing Coverage?	YES NO

Medical and/or PIP Coverage?	YES NO

VEHICLE #2 INFORMATION (if none, leave blank)
Year of vehicle:		Make & Model:
Vehicle ID# (for rating accuracy):
Annual Mileage:		Used in business? (Explain, if yes):

VEHICLE #2 COVERAGES:

Select Liability Limits	Liability Limits Must Match Vehicle #1

Select Comprehensive Deductible:

Select Collision Deductible:

Uninsured Motorists Coverage?	YES NO

Rental Car & Towing Coverage?	YES NO

Medical and/or PIP Coverage?	YES NO

VEHICLE #3 INFORMATION (if none, leave blank)
Year of vehicle:		Make & Model:
Vehicle ID# (for rating accuracy):
Annual Mileage:		Used in business? (Explain, if yes):

VEHICLE #3 COVERAGES:

Select Liability Limits	Liability Limits Must Match Vehicle #1

Select Comprehensive Deductible:

Select Collision Deductible:

Uninsured Motorists Coverage?	YES NO

Rental Car & Towing Coverage?	YES NO

Medical and/or PIP Coverage?	YES NO

VEHICLE #4 INFORMATION (if none, leave blank)
Year of vehicle:		Make & Model:
Vehicle ID# (for rating accuracy):
Annual Mileage:		Used in business? (Explain, if yes):

VEHICLE #4 COVERAGES:

Select Liability Limits	Liability Limits Must Match Vehicle #1

Select Comprehensive Deductible:

Select Collision Deductible:

Uninsured Motorists Coverage?	YES NO

Rental Car & Towing Coverage?	YES NO

Medical and/or PIP Coverage?	YES NO

Send my quotation via:

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"Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release proposal information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, 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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Saved over $1,000 on my insurance!
"This month I placed all my insurance with The O'Neill Group and saved over $1,000. I am extremely pleased with their personal service and especially saving that much money. Thank you Patrick!"
Tim DelMedico, Akron, OH