Diehl Insurance Agency

We have been an Independent Agency on Route 100 South in Trexlertown Serving Your Insurance Needs since 1947.

 

1217 South Route 100
Trexlertown, PA. 18087-0056
610-395-9200
610-395-1554 (fax)

E-mail:insure@fast.net

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Our agency is licensed to quote and write insurance policies only in Pennsylvania. To find agents offering these coverages in all other states, please click the IQ.net logo.

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Fill out this form and submit it to our agency to receive an accurate Automobile Insurance Quote

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Tell us the current coverages on your cars?

ACV 100 Ded 250 Ded None Comprehensive Deductible  ACV 100 Ded 250 Ded 500 Ded None   Collision Deductible 15/30 15/40 25/50 50/100 100/300 250/500   Bodily Injury Liability 5,000 10,000 25,000 50,000 100,000 250,000   Property Damage Liability Reject 15/30 15/40 25/50 50/100 100/300 250/500 Uninsured Motorist Coverage Reject 15/30 15/40 25/50 50/100 100/300 250/500   Underinsured Motorist Coverage 5,000 10,000 25,000 50,000 100,000    Medical 1,000/5,000 1,000/15,000 1,500/25,000 2,500/50,000   Income Loss REJECT 5,000 10,000 15,000 25,000   Accidental Death REJECT 1,500 2,500    Funeral FULL LIMITED   Tort Option Yes No   Road Service Coverage Yes No   Rental Car Reimbursement     FULL LIMITED   Stacked Uninsured/Underinsured Motorist Coverage YES NO   Have you had 6 months prior insurance?   If yes, what company? YES NO   Do you want full coverage on any vehicle?  Vehicle # All None 1 2 3 4   If yes, which one? (Select All) YES NO   Do you own your own home? CONVENTIONAL MOBILE   If yes, what type?

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Accidents & Violations
Last 3 Yrs (Minors) Last 5 Yrs (Majors)	Driver 1	Driver 2	Driver 3	Driver 4
Minor Violations - Speeding, Illegal Turn, Stop Sign, Red Light, etc. (Within the last 3 years)	None 1 2 3 4	None 1 2 3 4	None 1 2 3 4	None 1 2 3 4
Accidents - Non Chargeable (Within the last 5 years)	None 1 2 3 4	None 1 2 3 4	None 1 2 3 4	None 1 2 3 4
Accidents - Chargeable (Within the last 5 years)	None 1 2 3 4	None 1 2 3 4	None 1 2 3 4	None 1 2 3 4
Major Violations - Drunk Driving, Reckless, Hit & Run, Speeding - Greater than 30 MPH over limit (Within the last 5 years)	None 1 2 3 4	None 1 2 3 4	None 1 2 3 4	None 1 2 3 4

Please use this area to give us any additional information that you may feel is important for your insurance. ie: Is one of your cars used to deliver pizzas or conduct another type of business? Do your young drivers have a B average or better in school?

Are there any additional cars or drivers?

 

 

Vehicle Identification Numbers

Veh #1

Veh #2

Veh #3

 

auto/pa