Wilcox Insurance Agency
Get a Quote Home

Quick Links


Home


Pay Bill


Get a Quote


Other Services



Ask for a Quote

To get a quote on personal and commercial auto, home, life and health insurance you can call us at (432) 523-4157 during normal operating hours. Or you can stop by our office at 319 W Broadway, Suite C in Andrews, Texas. We are located across the street from the Shell gas pumps. We are happy to insure anyone, but can only insure persons inside the state of Texas. If you are looking for personal auto insurance and would like to send us your information online, you can fill in the form below.

* Denotes Required Field
Your Name*
Phone Number*
Email Address*
Your DOB*
Street Address*
City*
State Texas
Zip Code*
Please enter your spouses information, if applicable, even if he/she will not be a driver.
Spouse
Spouse DOB
Please enter the names and DOB of all other drivers of this car. Include anyone in your household over the age of 14 that you will be allowing to drive your car.
Other Drivers
Please enter any tickets you have gotten in the last 5 years. Also any accidents you have been in or insurance claims you have filed. Also list if you are required to submit an SR22.
Your Tickets/Accidents/Claims
Please enter any tickets your spouse has gotten in the last 5 years. Also any accidents he/she has been in or insurance claims he/she has filed. Also list if he/she is required to submit an SR22.
Spouses Tickets/Accidents/Claims
Please enter any tickets the other drivers listed above have gotten in the last 5 years. Also any accidents they have been in or insurance claims they have filed. Also list if they are required to submit an SR22.
Other Drivers Tickets/Accidents/Claims
Below list any Excluded Drivers and their DOB. List anyone over the age of 14 in your household that will not be driving this car. If you wish to exclude your spouse, write spouse in this box. These persons will not be covered by your insurance.
Excluded Drivers
Please enter your car information. Your car's Make/Model is required. If you know your VIN number enter it, else enter the number of doors and cylinders.
Car Make/Model*
Number of Doors
Number of Cylinders
VIN Number
Car2 Make/Model
Number of Doors
Number of Cylinders
VIN Number
Car3 Make/Model
Number of Doors
Number of Cylinders
VIN Number
Do you have more cars?
If any of your vehicles are pickups or SUVs, put yes if they are 4 wheel drive, and yes if you have customized them
4 wheel drive?
customization?
If this vehicle is for business use, please enter yes.
Business Use
If you will be commuting to work using this vehicle please enter yes
Commute
Enter the name of the registed owner listed on the Title of the car
Name of Registered Owner*
The following will be used to determine any discounts you may be entitled to
Do you own your own home
If yes, Is it a House of Mobile Home
How long have you lived at residence
Do you have previous car insurance
If yes, What company
If yes, when were you first insured
If yes, when does it expire
Have there been any lapses in coverage
Now select the type of coverage you would like. The minimum in the state of Texas is Liability.
Liability*
Persoanl Injury Protection pays your medical bills if you get into an accident and it is your fault.
Personal Injury Protection (PIP)
Uninsured Motorist coverage pays to have your car fixed if you get into an accident and it is the other parties fault, but they do not have insurance. If you want Uninsured Motorist coverage, select yes
Uninsured Motorist
Comprehensive/collision pays for damage to your car. If you have a loan on your car, you have to have Comprehensive/Collision.
Comprehensive/Collision
Towing coverage pays to tow your car if it is disabled to the nearest station
Towing
If you are in an accident, this coverage will pay for a rental car while your car is being repaired at the shop
Rental
If you are in an accident, and your car becomes completely unsalvageable. Pay-off coverage will pay the difference in the amount you owe on your car loan and the market value of your car if the amount you owe is more than the value of your car.
Pay-off

Want us to call you instead? No problem, just fill out the form below and we will give you a call during normal operating hours. We can only insure inside the state of Texas.

Your Name
Your Phone Number


Forms provided by EmailMeForm.com create web forms captcha
Copyright 2014 WilcoxInsurance.com
All Rights Reserved.