Welch Brand Insurance Services
1212 N. Locust
Denton, Texas 76201
P.O. Box 946
Denton, TX 76202
Phone: 940.220.7232
Fax: 888.310.1660

Email: insurance@ntin.net

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Counties:
Denton, Dallas, Cooke, Wise, Parker,
Collin and Tarrant

Including the cities of:
Denton, Lake Dallas, Hickory Creek, Corinth, Flower Mound, Lewisville, Argyle, Pilot Point, Plano, Frisco, Dallas, Keller, Forth Worth, Aubrey, Sanger and Gainesville

 

Auto Insurance Quote

Premium quotes are based on the rates effective at the time the quote is made. They are for informational purposes only and are subject to the accuracy of the information provided by the individual requesting the quote.

This is not an implicit offer of insurance. Actual rate quotations are based on an individual customer needs analysis and are calculated with specific information provided by the applicant to the agent.



 

 

 
Products and services are subject to all eligibility requirements stated in the policy.

 
Please compelete the following information and hit the "Submit" button.
 
Name:
Address:
City:
State:
Zip:
County:
E-Mail Address:
(we send quotes here)
Phone:
Phone:
Fax:
Contact me:

Driver #1 Information

Name:
Gender:
Date of Birth: (mm/dd/yyyy)
Marital Status:
Drivers License #:
State Drivers License was issued:
Defensive Driving?:
Education level:

Driver #1 Claims/Tickets Information
Date of claim/ticket:
Briefly describe the incident:
Date of claim/ticket:
Briefly describe the incident:

Driver #2 Information (if applicable)

Name:
Gender:
Date of Birth: (mm/dd/yyyy)
Marital Status:
Drivers License #:
State Drivers License was issued:
Defensive Driving?:
Education level:

Driver #2 Claims/Tickets Information
Date of claim/ticket:
Briefly describe the incident:
Date of claim/ticket:
Briefly describe the incident:

Driver #3 Information (if applicable)

Name:
Gender:
Date of Birth: (mm/dd/yyyy)
Marital Status:
Drivers License #:
State Drivers License was issued:
Defensive Driving?:
Education level:

Driver #3 Claims/Tickets Information
Date of claim/ticket:
Briefly describe the incident:
Date of claim/ticket:
Briefly describe the incident:

Claims History / Credit Information

In order to give an accurate quote, we will need your Social Security Number and permission run a claims history & credit score. Please provide SSN's for all drivers in the boxes below. This does not effect your credit rating in any way.
Driver #1 Social Security Number:
Driver #2 Social Security Number:
Driver #3 Social Security Number:

Insurance Carrier Information

Are you currently insured:
If yes, who is your carrier?
How long?
 years
Policy Expiration date: (mm/dd/yyyy)

Vehicle #1 Information

Vehicle Year:
Make:
Model:
VIN#:
Anti-theft device:
Annual Miles Driven:
Miles to Work (one way):
Primary Driver:

Vehicle #1 - Select limits with your current insurance carrier if currently insured.

Bodily Injury:
Property Damage:
Medical Pay:

Uninsured/Underinsured Motorist Bodily Injury:
(if chosen, must be the same as Bodily Injury)
Uninsured/Underinsured Motorist Property Damage:
(if chosen, must be the same as Property Damage)
Comprehensive Deductible:
Collision Deductible:
Towing and Labor:
Rental Reimbursement:
Personal Injury Protection:

Vehicle #2 Information (if applicable)

Vehicle Year:
Make:
Model:
VIN#:
Anti-theft device:
Annual Miles Driven:
Miles to Work (one way):
Primary Driver:

Vehicle #2 - Select limits with your current insurance carrier if currently insured.

Limits are same as Vehicle #1:
(if same, you are not required to complete info below)
Bodily Injury:
Property Damage:
Medical Pay:

Uninsured/Underinsured Motorist Bodily Injury:
(if chosen, must be the same as Bodily Injury)
Uninsured/Underinsured Motorist Property Damage:
 (if chosen, must be the same as Property Damage)
Comprehensive Deductible:
Collision Deductible:
Towing and Labor:
Rental Reimbursement:
Personal Injury Protection:

Vehicle #3 Information (if applicable)

Vehicle Year:
Make:
Model:
VIN#:
Anti-theft device:
Annual Miles Driven:
Miles to Work (one way):
Primary Driver:

Vehicle #3 - Select limits with your current insurance carrier if currently insured.

Limits are same as Vehicle #1:
(if same, you are not required to complete info below)
Bodily Injury:
Property Damage:
Medical Pay:

Uninsured/Underinsured Motorist Bodily Injury:
(if chosen, must be the same as Bodily Injury)
Uninsured/Underinsured Motorist Property Damage:
 (if chosen, must be the same as Property Damage)
Comprehensive Deductible:
Collision Deductible:
Towing and Labor:
Rental Reimbursement:
Personal Injury Protection:

Vehicle #4 Information (if applicable)

Vehicle Year:
Make:
Model:
VIN#:
Anti-theft device:
Annual Miles Driven:
Miles to Work (one way):
Primary Driver:

Vehicle #4 - Select limits with your current insurance carrier if currently insured.

Limits are same as Vehicle #1:
(if same, you are not required to complete info below)
Bodily Injury:
Property Damage:
Medical Pay:

Uninsured/Underinsured Motorist Bodily Injury:
(if chosen, must be the same as Bodily Injury)
Uninsured/Underinsured Motorist Property Damage:
 (if chosen, must be the same as Property Damage)
Comprehensive Deductible:
Collision Deductible:
Towing and Labor:
Rental Reimbursement:
Personal Injury Protection: