Step 1
of 3 - Provide General
Information!
*
Today's Date
Select Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
*
Current
Time
Select Hour
01
02
03
04
05
06
07
08+
09
10
11
12
Minute
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
am/pm?
AM
PM
* First Name
* Last
Name
*
Date of
Birth
Select Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1917
1918
1919
1920
1921
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Address
* City
*
County
Please Select County
Alachua
Baker
Bay
Bradford
Brevard
Broward
Calhoun
Charlotte
Citrus
Clay
Collier
Columbia
Dade
Desoto
Dixie
Duval
Escambia
Flagler
Franklin
Gadsden
Gilchrist
Glades
Gulf
Hamilton
Hardee
Hendry
Hernando
Highlands
Hillsborough
Holmes
Indian River
Jackson
Jefferson
Lafayette
Lake
Lee
Leon
Levy
Liberty
Madison
Manatee
Marion
Martin
Miami-Dade
Monroe
Nassau
Okaloosa
Okeechobee
Orange
Osceola
Palm Beach
Pasco
Pinellas
Polk
Putnam
Santa Rosa
Sarasota
Seminole
Suwannee
St. Johns
St. Lucie
Sumter
Taylor
Union
Volusia
Wakulla
Walton
Washington
* State
Please Select State
Alabama
Alaska Arizona
Arkansas California Colorado
Connecticut Delaware District of Columbia FLORIDA Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky
Louisiana Maine Maryland Michigan Minnesota
Mississippi Missouri Montana
Nebraska Nevada New Hampshire
New Jersey New
Mexico New York North Carolina North
Dakota Ohio Oklahoma Oregon
Pennsylvania Rhode
Island South Carolina South Dakota Tennessee
Texas Utah
Vermont Virginia Washington
West Virginia Wisconsin Wyoming
* Zip Code
-
* Telephone 1
- -
Telephone 2
- -
* E-mail Address
* Confirm E-mail Address
Step 2
of 3 - Provide "ALARM"
Information!
QUOTE ALARM 1
Insurance- AAA -Alert!
Receive (3) different
"QUOTE ALARMS! "
* Currently Insured?
Are you Insured Now?
YES
NO
* Currently Insured by?
* Type of Insurance?
Type of Insurance for QUOTE ALARM!
AUTOMOTIVE QUOTE ALARM
HOMEOWNERS INSURANCE AERT!
COMMERCIAL QUOTE ALARM!
* Policy Expiration Date?
Policy Expires - Select Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2006
2007
2008
2009
2010
2011
2012
*
Monthly Payment $
What is you current Monthly Payment?
* Down
Payment $
What was you current Down Payment?
* Monthly
Payment Date?
Day of Month Insurance Payment Made
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Comment for this Alert!
QUOTE ALARM 2
Insurance- AAA -Alert!
Receive (3) different
"QUOTE ALARMS! "
* Currently Insured?
Are you Insured Now?
YES
NO
* Currently Insured by?
* Type of Insurance?
Type of Insurance for QUOTE ALARM!
AUTOMOTIVE QUOTE ALARM
HOMEOWNERS INSURANCE AERT!
COMMERCIAL QUOTE ALARM!
* Policy Expiration Date?
Policy Expires - Select Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2006
2007
2008
2009
2010
2011
2012
*
Monthly Payment $
What is you current Monthly Payment?
* Down
Payment $
What was you current Down Payment?
* Monthly
Payment Date
Day of Month Insurance Payment Made
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Comment for this Alert!
QUOTE ALARM
3
Insurance- AAA -Alert!
Receive (3) different
"QUOTE ALARMS! "
* Currently Insured?
Are you Insured Now?
YES
NO
* Currently Insured by?
* Type of Insurance?
Type of Insurance for QUOTE ALARM!
AUTOMOTIVE QUOTE ALARM
HOMEOWNERS INSURANCE AERT!
COMMERCIAL QUOTE ALARM!
* Policy Expiration Date?
Policy Expires - Select Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2006
2007
2008
2009
2010
2011
2012
*
Monthly Payment $
What is you current Monthly Payment?
* Down
Payment $
What was you current Down Payment?
* Monthly
Payment Date
Day of Month Insurance Payment Made
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Comment for this Alert!
Step 3 of 3 - Sign Up
Now for
Insurance- AAA -Alert!
Comment Here!
