Information submitted will be held confidential and will be used for quote purposes only.
By pressing Submit you are authorizing us to verify any information including credit scoring,
if applicable, to provide you with the best rates and most accurate quote.
No Coverage will be bound by this form.
I authorize AIC to use my information in my file to remarket or check other insurance companies they represent, for the overages or polices on my behalf until I revoke this authority, this includes social security numbers, state drivers license numbers, address and phone numbers. Information will be used for insurance purposes only.