Stone's General Insurance
 
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Stone's General Insurance  .  21394  Great Mills Road  .  Lexington Park, Maryland  20653-0547
Phone : 301 - 862 - 5100  .  Fax : 301 - 862 - 5102  .  Harry  D. Stone - Broker
Office Hours are : Monday - Thursday  9:00  to  5:00  .  Friday  9:00  to  7:00  .  Saturday  9:00  to  12:00
E-Mail Us At: quotes@stonesgeneralins.net © 2007  .  Website Design © 2007 .  Creative Printings
About  Us
 
Service My Account
Having Trouble?   Same Day Coverage!
      Monday - Thursday  9 a.m. - 5 p.m.   
    Extended Hours Friday 9 a.m. - 7 p.m.
            Saturday  9 a.m.  - 12 p.m.
Call (301) 862 - 5100
Your  Personal  Data
Automobile Insurance Quote Form
One Simple Form - takes only 5 - 10 Minutes !
Name: ( * Required )
Street Address:
City:
County:
State:
Zip / Postal Code:
E- Mail: ( * Required )
E- Mail: ( *  Confirm )
Phone: ( * Required )
Fax: ( Optional )
Driver # 1  Information
Vehicle # 1 Information
E- Mail
Fax
Regular Mail
By Phone
Thank you for filling out this form COMPLETELY !
Yes, I Agree. Please Send Me A Quote !
Click button below when done
Please click only once ... May take up to 30 seconds !
Marital Status:
Single
Married
Homeowner ?
Yes
No
Currently Insured ?
Name:
Birthdate:
(If yes, list carrier, and # of years
continuous. If none, type N/C)
mm / dd / yy
Sex:
Male
Female
# Years U.S. Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years:
Number & Type of MAJOR violations last 3 years:
Number & Type of MINOR violations last 3 years:
Daily commute
in ONE WAY miles:
Does Driver need
an SR22 FILING?
Yes
No
If YES to SR22 filing,
why needed?
( list accident / citations )
Driver # 2  Information
Name:
Birthdate:
mm / dd / yy
Sex:
Male
Female
# Years U.S. Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years:
Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years:
Daily commute
in ONE WAY miles:
If YES to SR22 filing,
why needed?
( list accident / citations )
Does Driver need
an SR22 FILING?
Yes
No
If More than 2 Drivers , list
Additional Driver 's Name(s) ,
Birthdate(s) , and Driving Record History here:
( If  " Non-Owner  " ,  type  " Non-Owner "  in  " Year "  Field )
Year of vehicle:
Vehicle Identification Number ( VIN # ):
Vehicle make:
Vehicle Model:
Annual Mileage:
Will vehicle be used
in a business?
( If yes , Explain )
Yes
No
Vehicle # 1 Coverages
Helpful Tip:
When selecting coverage compare
your current policy coverages.
Select Liability Limits:
__________________________________________________________________
Send my quote via:
Select Comprehensive Deductible:
Select Collision Deductible:
Towing:
Uninsured Motorist:
Rental:
GAP:
Additional Coverages:
Yes
No
Other Coverages: (List in Remaks)
Standard
$ 2,500.00 limit
Other Limit:
Waived:
Maryland PIP:
Amount:
List any additional coverages, or vehicles inluding year, make, model, & Vin # here:
We value your input as PRIVATE information. Every step has been taken to insure your
privacy and security. Our intent is to release quote information only to you. We will not
give your data to ANY other person or group for sales, marketing, or ANY other purposes.
By checking the box below you agree to allow our agency to release this information via
the method you have chosen, and to release us from any liability should this information
be accidentally viewed by others. It is our intention to maintain your complete privacy.
Limits of Coverages
Remarks:
__________________________________________________________________
Telephone Quotes Encouraged - Call Now !
Online Quotes will Normally be returned within 1 Business Day !