Dooley Dereemer Orr Agency Inc. - Home, Auto, Life and Business Insurance in New York

Add A New Car

Submitting information from this web-site does not bind coverage or acknowledge receipt. You must receive a written or e-mailed confirmation from us to acknowledge or bind coverage.

What is your name?
Email Address?
Phone number?

Are you adding a car or replacing a car currently on your policy? Add Replace
If replacing, which car are you replacing?
What date are you picking up your new car?
Information on this new car:

Make
Model
Year
# of doors
VIN#

What kind of alarms and safety devices does your car have?
Passive Disabling Device
(car will not start if alarm is not turned off)
Vehicle Recovery System (Lojack)
Daytime Running Lights
Drivers side only Airbags
Dual Airbags (Passenger and Drivers side)

Does this car have a loan or lease?
Loan Lease No loan or lease

If loan or lease, what is the name and address of the lienholder or loss payee (bank).

How is this car used?
Drive to work or transportation 3 or more miles
Drive to work or transportation less than 3 miles
Pleasure use only

What deductibles would you like?
Same as other cars on my policy.
200 Comprehensive (other than collision) 200 Collision
500 Comprehensive (other than collision) 500 Collision
1000 Comprehensive (other than collision) 1000 Collision

Would you like Full Glass Coverage? Yes No

Who drives this car?
Name
Is this driver already on the policy? Yes No
If not, please give:

Date of Birth
Drivers Lic.#

How long has this driver been licensed?
Over 3 years. Less than 3 years.