WBW Insurance Agency, Inc. Bill West, Gurnee WBW Insurance Agency, Inc. Bill West, Gurnee WBW Insurance Agency, Inc. Bill West, Gurnee
Bill West - Illinois and Wisconsin Insurance Agent

Bill West - Wm B West Insurance Agency, Inc.
Illinois & Wisconsin (224) 538-2006
WBW Insurance Agency, Inc. Bill West, Gurnee
Request an Insurance Quote for:

Non-Commercial Automobile Insurance
Contact Information
We can only underwrite businesses and residents located in Illinois and Wisconsin.
 
Name
Street Address
City
State
 Zip
 
Contact Name
Phone
Fax
Email
 
Current Insurance Information   Personal Information
 
Are you currently insured?
Yes   No
If "yes" list the name of the carrier and number of years continuous.
Please list claims and amounts paid
 
Marital Status:
Single
Married
Homeowner:
Yes
No
 
Driver Information
 
How many drivers do you need to insure?
If it is more than 2 please list additional drivers' names, birthdates, and driving record history here:
DRIVER #1:
Name
Birthdate:
Sex: Male Female
# of Years US Driver's License
# and Type of Accidents within last 3 years:
# and Type of Minor Citations within last 3 years:
# and Type of Major Citations within last 3 years:
How many miles is one-way daily commute?
Does driver need an SR22 Filing? Yes No
If yes, why?
 
DRIVER #2:
Name
Birthdate:
Sex: Male Female
# of Years US Driver's License
# and Type of Accidents within last 3 years:
# and Type of Minor Citations within last 3 years:
# and Type of Major Citations within last 3 years:
How many miles is one-way daily commute?
Does driver need an SR22 Filing? Yes No
If yes, why?
 
Vehicle Information
 
How many vehicles do you need to insure?
If it is more than 2 we will contact you for additional vehicle information.
VEHICLE #1:
Make and Model:
Year of Vehicle:
Annual Mileage:
If this vehicle is used for business, explain here:
 
COVERAGE FOR VEHICLE #1:
Limits of Liability:
$100/300 BI/ 100 PD $250/500 BI/ 100 PD $300,000 CSL
$500,000 CSL $1 Million +
Comprehensive Coverage:
No Coverage $250 Deductible
$500 Deductible $1000 Deductible
Collision Coverage:
No Coverage $250 Deductible
$500 Deductible $1000 Deductible
Rental Car and Towing?
yes no
 
VEHICLE #2:
Make and Model:
Year of Vehicle:
Annual Mileage:
If this vehicle is used for business, explain here:
 
COVERAGE FOR VEHICLE #1:
Limits of Liability:
$100/300 BI/ 100 PD $250/500 BI/ 100 PD $300,000 CSL
$500,000 CSL $1 Million +
Comprehensive Coverage:
No Coverage $250 Deductible
$500 Deductible $1000 Deductible
Collision Coverage:
No Coverage $250 Deductible
$500 Deductible $1000 Deductible
Rental Car and Towing?
yes no
 

 
 
The information on these pages is intended to be accurate at the time posted. It is for general informational purposes only. Because of the nature of this information, it may not be applicable in your area or current at the time you read it. Please see your agent or review the policy contract for detailed information you can rely on. The information on this site may change without prior notice.
 
Business Owners   Workers Compensation   General Liability   Commercial Property   Commercial Vehicle   Business Umbrella
Auto Insurance   Homeowner's Insurance   Property Dwelling Insurance  
Certificate of Inusrance   Contact WBW Insurance Agency   Return to Home Page