Many people have chosen the Unruh Insurance Agency for their auto insurance because of the competitive rates we offer through the companies we represent. We also provide the highest level of customer service. We can review your present insurance needs to make sure you are properly insured, or we can suggest changes that may be of value to you. We offer many discounts on car insurance:

• Multi policy discount
• Good driver discount
• Accident forgiveness
• Age 55 discount
• Auto safety features discount
• …and many more.

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Get a quote from the following providers or complete form below. * = Required Fields * Name: * Address: * City: * State: * Zip: * E-mail: * Phone:   Daytime Evening Marital Status: Married Single Employer: * Names of all Drivers: * Ages of Drivers: 1. 2. 3. 4. 1. 2. 3. 4. Automobile Information: Year: 1. 2. 3. 4. Make/Model: 1. 2. 3. 4. V.I.N. (if available): 1. 2. 3. 4. Distance one way to work: 1. 2. 3. 4. Any accidents or violations in the last three years? Yes No If yes: Driver # 1. 2. 3. 4.   When 1. 2. 3. 4.   Payout 1. 2. 3. 4.   Violation 1. 2. 3. 4. Current Insurance Company: Date coverage needs to be effective: JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 OUR CURRENT COVERAGES: Tort Option: Full Tort Limited Tort Liability Limits: Single Limits (Bodily Injury & Property Damage) Select One $ 35,000 $ 50,000 $ 75,000 $100,000 $200,000 $300,000 $500,000 Split Limits Bodily Injury: Select One $ 15,000/$ 30,000 $ 20,000/$ 40,000 $ 25,000/$50,000 $ 50,000/$100,000 $100,000/$200,000 $100,000/$300,000 $250,000/$500,000 Property Damage: Select One $ 5,000 $ 10,000 $ 20,000 $ 25,000 $ 50,000 $100,000 Uninsured Motorist Coverage Single Limits Bodily Injury: Select One $ 35,000 $ 50,000 $ 75,000 $100,000 $200,000 $300,000 $500,000 Split Limits Bodily Injury: Select One $ 15,000/$ 30,000 $ 20,000/$ 40,000 $ 25,000/$50,000 $ 50,000/$100,000 $100,000/$200,000 $100,000/$300,000 $250,000/$500,000 Stacked Unstacked Underinsured Motorist Coverage Single Limits Bodily Injury: Select One $ 35,000 $ 50,000 $ 75,000 $100,000 $200,000 $300,000 $500,000 Split Limits Bodily Injury: Select One $ 15,000/$ 30,000 $ 20,000/$ 40,000 $ 25,000/$50,000 $ 50,000/$100,000 $100,000/$200,000 $100,000/$300,000 $250,000/$500,000 Stacked Unstacked Basic First Party Benefits Coverage Limits Options Medical Benefit: Select One $ 5,000 (basic) $ 10,000 $ 25,000 $ 50,000 $100,000 Work Loss Benefit (Monthly/Maximum): Select One Coverage Rejected $1,000/$5,000 $1,000/$15,000 $1,500/$25,000 $2,500/$50,000 Funeral Expense Benefit: Select One Coverage Rejected $1,500 $2,500 Accidental Death Benefit: Select One Coverage Rejected $5,000 $10,000 $25,000 Extraordinary Medical Benefits Coverage Limits Option Single Limits (Medical and Rehabilitation): Select One Coverage Rejected $1,000,000 Questions/Comments:

1344 Main Street Shady Maple Complex East Earl, PA 17519

2350 North Reading Road Suite 13 Denver, PA 17517

Toll Free: 1.877.854.3309 Local: 717.335.2929 Denver Fax: 717.335.2923 East Earl Fax: 717.351.5431

Mon and Wed: 9am - 7pm Tue, Thu, Fri: 9am - 5:30pm Saturday: 9am - 12pm by Appt Only