HUGHES ASSOCIATES, INC.
71-14 Myrtle Avenue
Glendale, NY 11385

Phone: (718) 456-8646
Phone: (516) 354-2171
Fax: (718) 456-8797


    

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General Information

First Name                       
Last Name             
Address                 
City                            State        Zip   
Home Telephone        
Email Address       
                    Year                    Make                              Model
Vehicle 1 
Vehicle 2 
Vehicle 3 
Vehicle 4 


Vehicle Usage

Use of Vehicle 1 (required)          
Use of Vehicle 2 (if applicable)     
Use of Vehicle 3 (if applicable)     
Use of Vehicle 4 (if applicable)     


Driver Information

NameDate of BirthSexMarital Status
Driver 1
Driver 2
Driver 3
Driver 4


Have you had any accidents in the last 5 years?

Violation DateViolation Code
Driver 1
Driver 2
Driver 3
Driver 4


Automobile Insurance Coverage Information

What are your current liability limits for bodily injury and property damage?


Comprehensive Coverage

Deductible Vehicle 1 (if applicable)
Deductible Vehicle 2 (if applicable)
Deductible Vehicle 3 (if applicable)
Deductible Vehicle 4 (if applicable)


Collision Coverage

Deductible Vehicle 1 (if applicable)
Deductible Vehicle 2 (if applicable)
Deductible Vehicle 3 (if applicable)
Deductible Vehicle 4 (if applicable)


          
  


© Hughes Associates Inc  All rights reserved

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Hughes Associates, Inc. is conveniently located close to Glendale, Middle Village, Richmond Hill, Woodhaven, Ridgewood, Maspeth Queens, and Cypress Hills Brooklyn, NY.

We service all of the 5 boroughs - Queens, Brooklyn, Manhattan, Staten Island, and Bronx, New York as well as Westchester, Nassau County, Suffolk County, Rockland County, Putnam County and Upstate New York. We also service Parts of Connecticut (CT) and New Jersey (NJ)