The quotes provided here are for Massachusetts only. Fill out the form below to obtain a Massachusetts auto quote. All blue fields are required. Be careful to include their information before submitting your form. You may add up to 4 drivers and 2 vehicles on this quote form. For additional vehicles or drivers, feel free to call us. For state of Massachusetts explanations of the coverages down in the "Insurance Coverages" section, click the "?" button next to the coverage. These help links connect you with the Massachusetts Division of Insurance website explanations of the various insurance coverages. The quotes provided here are for Massachusetts only. Vehicle(s) Registration Information Section (Mandatory) The name and address to which the vehicle(s) is or will be registered: *Name: Street: City/State/Zip: / / Home Phone: Work Phone: *Email Address: Driver Information Section State Licensed: Driver 1 Select State Massachusetts Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Washington Washington D.C. Driver 2 Select State Massachusetts Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Washington Washington D.C. Driver 3 Select State Massachusetts Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Washington Washington D.C. Driver 4 Select State Massachusetts Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Washington Washington D.C. Years of Driving Experience: Driver 1 Select Years 6 + 3 - 6 0 - 3 Driver 2 Select Years 6 + 3 - 6 0 - 3 Driver 3 Select Years 6 + 3 - 6 0 - 3 Driver 4 Select Years 6 + 3 - 6 0 - 3 If less than 3 years, have you completed a course in Driver Training? Driver 1 Select Yes/No No Yes Driver 2 Select Yes/No No Yes Driver 3 Select Yes/No No Yes Driver 4 Select Yes/No No Yes Drivers License Number: Driver 1 Driver 2 Driver 3 Driver 4 Date of Birth Driver 1 dd/mm/yy Driver 2 dd/mm/yy Driver 3 dd/mm/yy Driver 4 dd/mm/yy Please check what applies to the driver: Driver 1 Over the age of 65 Purchased a monthly transit pass (at least 11 months) Driver 2 Over the age of 65 Purchased a monthly transit pass (at least 11 months) Driver 3 Over the age of 65 Purchased a monthly transit pass (at least 11 months) Driver 4 Over the age of 65 Purchased a monthly transit pass (at least 11 months) Has driver had any at-fault accidents or moving violations in the past six (6) years? Driver 1 Select Yes/No No Yes Driver 2 Select Yes/No No Yes Driver 3 Select Yes/No No Yes Driver 4 Select Yes/No No Yes If yes, please give a brief description: Driver 1 Driver 2 Driver 3 Driver 4 Vehicle Information Section Year Vehicle 1 Vehicle 2 Make Vehicle 1 Vehicle 2 Model (Please be as specific as possible. i.e.. Honda Accord LX, 4 door) Vehicle 1 Vehicle 2 City Primarily Garaged: Vehicle 1 Vehicle 2 Please check all that apply to this vehicle. Airbags Vehicle 1 Vehicle 2 Automatic Seatbelts Vehicle 1 Vehicle 2 Drive less than 5,000 miles per year Vehicle 1 Vehicle 2 Drive between 5,000 miles and 7,500 miles per year Vehicle 1 Vehicle 2 Antitheft device (Alarm) Vehicle 1 Vehicle 2 Vehicle Recovery System (LoJack) Vehicle 1 Vehicle 2 Insurance Coverages Section Compulsory Insurance (Mandatory) 1. *Bodily Injury to Others: Vehicle 1 $20,000 per person / $40,000 per accident Vehicle 2 $20,000 per person / $40,000 per accident 2. *Personal Injury Protection: Vehicle 1 $8,000 per person Vehicle 2 $8,000 per person 3. *Bodily Injury caused by uninsured auto: Vehicle 1 $20,000 per person / $40,000 per accident $25,000 per person / $50,000 per accident $35,000 per person / $80,000 per accident $50,000 per person / $100,000 per accident $100,000 per person / $300,000 per accident $250,000 per person / $500,000 per accident Vehicle 2 $20,000 per person / $40,000 per accident $25,000 per person / $50,000 per accident $35,000 per person / $80,000 per accident $50,000 per person / $100,000 per accident $100,000 per person / $300,000 per accident $250,000 per person / $500,000 per accident 4.* Damage to someone else's property: Vehicle 1 $5,000 $10,000 $25,000 $50,000 $100,000 $250,000 Vehicle 2 $5,000 $10,000 $25,000 $50,000 $100,000 $250,000 Optional Insurance 5. Optional Bodily Injury To Others: Vehicle 1 $20,000 per person / $40,000 per accident $25,000 per person / $40,000 per accident $25,000 per person / $50,000 per accident $35,000 per person / $80,000 per accident $50,000 per person / $100,000 per accident $100,000 per person / $300,000 per accident $250,000 per person / $500,000 per accident Vehicle 2 $20,000 per person / $40,000 per accident $25,000 per person / $40,000 per accident $25,000 per person / $50,000 per accident $35,000 per person / $80,000 per accident $50,000 per person / $100,000 per accident $100,000 per person / $300,000 per accident $250,000 per person / $500,000 per accident 6. Medical Payments: Vehicle 1 No Coverage $5,000 per person $10,000 per person $15,000 per person $20,000 per person $25,000 per person Vehicle 2 No Coverage $5,000 per person $10,000 per person $15,000 per person $20,000 per person $25,000 per person 7. Collision Coverage/ Deductible: Vehicle 1 300 500 1000 No Coverage Vehicle 2 500 300 1000 No Coverage 8. Limited Collision: Vehicle 1 Yes No Vehicle 2 Yes No 9. Comprehensive Coverage: Vehicle 1 300 500 1000 No Coverage Vehicle 2 300 500 1000 No Coverage 10. Substitute Transportation: Vehicle 1 No Coverage $15 per day $30 per day $100 per day Vehicle 2 No Coverage $15 per day $30 per day $100 per day 11. Towing and Labor: Vehicle 1 No Coverage $25 per incident $50 per incident Vehicle 2 No Coverage $25 per incident $50 per incident 12. Bodily Injury caused by underinsured: Vehicle 1 $20,000 per person / $40,000 per accident $25,000 per person / $50,000 per accident $35,000 per person / $80,000 per accident $50,000 per person / $100,000 per accident $100,000 per person / $300,000 per accident $250,000 per person / $500,000 per accident Vehicle 2 $20,000 per person / $40,000 per accident $25,000 per person / $50,000 per accident $35,000 per person / $80,000 per accident $50,000 per person / $100,000 per accident $100,000 per person / $300,000 per accident $250,000 per person / $500,000 per accident End of Form Select Response Method, then click the Submit button below Response Method I would like my quote sent to me via: Email Postal Mail Fax Fax Number: Mailing Address: Street: City/State/Zip: / / You have completed the preliminary business/ commercial insurance application. Please review to be sure all required information has been provided. Thank you for considering Gulde Insurance. We will provide you with a quote within 48 Hours of our receipt of your request Please provide the following information. Who referred you to Gulde Insurance? How did you hear about Gulde Insurance?
1. *Bodily Injury to Others:
2. *Personal Injury Protection:
3. *Bodily Injury caused by uninsured auto:
Optional Insurance
