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208-466-4800

AUTO INSURANCE QUOTE

from Waters Premier Insurance

Fill out the form below & an experienced agent will be in touch ASAP to get started quoting your auto insurance.

Personal Information

First name ✶

Last name ✶

Street address ✶

City ✶

State ✶

ZIP ✶

Phone

Preferred contact method(s) ✶

Call

Text

Vehicle Information

Vehicle

Year ✶

Make ✶

Model ✶

Name on title

Purchase date

VIN

Vehicle uses ✶

Pleasure

Work

School

Other

Ownership

Loan

Lease

Own

Loan/lease info (if applicable)

Company name

Company address

Driver Information

Driver

First name ✶

Last name ✶

Date of birth ✶

Occupation

Annual mileage ✶

miles

Insurance Coverage Information

Currently insured?

Yes

Number of claims in past 5 years

Current Insurance Policy

Insurance company

Policy expiration

Coverage amount

Current policy declarations page (PDF)

This is optional but can help us with the quoting process

New Insurance Policy Options

Coverage preference

Best coverage

Lowest deductible

Lowest rate

State minimum

Not sure

Other

Please describe your coverage preferences

Coverage options

GAP / replacement cost

Medical payments

Rental reimbursements

Towing & roadside assistance

Uninsured/underinsured motorist

Other

What other coverage options would you like?

Comments or questions

I understand that insurance coverage is not bound or altered until I receive confirmation by an authorized representative of Waters Premier Insurance ✶

Subject

Please leave this field blank. This field is here to help us protect against automated submissions. If you put something into this field, your entire submission will be ignored.

Secure form

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Licensed in Idaho, Oregon, Washington, and Arizona

help [at] WatersPremierInsurance [dot] com

1713 12th Avenue Road
Nampa, ID 83686

208-466-4800

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