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"Thanks for visiting our agency's website! Low rates, quality service, and top rated, insurance companies make our agency's car insurance plans unbeatable. Get a quote today!"

Immanuel Insurance Agency, Inc.
3 Brittany Lane
PO Box 300
Barrington, NH 03825

Phone: 603-335-4300
Toll Free: 800-464-5960
Fax: 603-822-7101

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On-Line New Hampshire Auto
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!

Accidents? Tickets? DUI's? NO PROBLEM! Our fast and friendly agents will shop top New Hampshire insurance companies to make sure your auto insurance is as cheap as possible!


Your Personal Data

Your Name:
Street Address:
State: (Must be New Hampshire)
Zip Code:
E-Mail again for accuracy:
OPT-OUT SELECTION: We realize your time is valuable. Rather than fill in all the underwriting information below, would it be easier to have us call you? If so, you can check the "Opt-Out" box above, press the send button at the bottom of this form, and have a friendly agent call you. If possible, please have your current policy handy as this has helpful information we may need.

If you want to continue the complete online quoting process, do NOT check the box and please continue below.

Primary Insured's Occupation:
Primary Insured's Company Sponsor, if any:
Primary Insured's Education Level:
Marital Status:
Single Married
Yes No
Currently Insured?
(If yes, list carrier. If none, type No coverage)
What is Cost of Current Coverage
and Expiration Date?

Name: Birthdate:
Sex (M/F): # Years U.S.
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 5 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Describe
Vehicle Use:
If Car is Driven to Work, List
One-Way Mileage Here:
Does Driver need
Yes No If YES to SR22 filing, why needed?
Give details on all violations or accidents:

(if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
Year of vehicle: Make & Model:
Annual Mileage: Used in business?
Select Liability Limits
Select Comprehensive Deductible:
Select Collision Deductible:
Rental Car &
Towing Coverage?
Are there residents in the household, ages 16 and over? (List Names & Ages in remarks below) YES NO
Comments or Remarks:
If More than 1 Vehicle or Driver, list Additional Vehicles (Year, Makes, and Models), and Drivers (Names, Ages, and Driving records):

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Auto is a New Hampshire insurance agency with highly qualified professionals committed to finding the best coverages and prices for your Personal Auto Insurance needs.

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