Welcome to A&J Insurance, click on one of the links below to obtain a free, no obligation insurance quote:

The Home Page Request an Auto Insurance Quote Request a Home Insurance Quote Request a Life Insurance Quote Request a Health Insurance Quote Contact Us!

Please take a second to read our disclaimer before continuing:
A & J Insurance Agency does not express or imply any insurance coverage by your completing the quote request form or by our responding with a price comparison. Coverage can only be obtained upon completion of a company-approved application and with receipt of the appropriate premium down payment.
Auto Insurance Quote Form (Nevada Only)
To request a quote, please complete the form entirely. If currently insured, your policy's declaration page will have much of the needed information. All items marked with a red tag are required to be completed:
General Information:
First Name:
Last Name:
Address:
City, State & Zip:
Phone Day / Eve:
Fax number:
Best time to call (eg, "after 2pm"):
Email:
Primary residence:
Have you had a bankruptcy, foreclosure, repossession, lien, judgment or adverse credit in the past 5 years?
 yes no
Are you currently insured?
 yes no
If yes: Company Name, (not agency):
Policy Expiration Date:
Premium:
Length of time continuously insured (without a lapse in coverage):
Vehicles in your household:
Veh# Year Make Model Body Type Vehicle ID# (VIN)
1.
2.
3.
4.
Continued:
Veh# Use If commute,
miles 1-way		 Airbag Alarm Anti Lock Brakes
1.
2.
3.
4.
Continued:
Veh# # of Cylinders Is the Vehicle Leased? Garaging Zip Code, if different from address
1. Yes No
2. Yes No
3. Yes No
4. Yes No
Coverage:
Bodily Injury
Property Damage
Uninsured Motorist /
Underinsured Motorist
Medical Payments
Veh# Comprehensive Deductable Collision Deductable Towing Loss of Use
1. Yes No Yes No
2. Yes No Yes No
3. Yes No Yes No
4. Yes No Yes No
Drivers- List all licensed drivers in your household. If anyone is 16 years or older and is not licensed, please explain in comments.
  Name Drives Veh # Gender Birth Date Marital Status
1.
2.
3.
4.
Drivers Continued:
Driver # Relation How long licensed State licensed Occupation
1.
2.
3.
4.
List all tickets and accidents for all drivers during the last 3 years.
Driver # Date Violation or Description of Accident
Do you need to file a financial responsibility form (SR22)? Yes No
If yes, drivers name(s) and state for filing.
Are there any other claims in the last 3 years? Yes No - If yes, please describe in comments.
Is any vehicle modified to increase speed or performance or is there any non-factory custom parts and equipment you want covered? Yes No - If yes, please describe in comments.
Are there any felony convictions for any drivers in the last 10 years? Yes No
Comments:
Deliver quote VIA:
Phone
Fax
E-Mail
Mail
Click below to submit for quote:

A&J Insurance, Las Vegas Nevada 5601 N. Tenaya Ste. 103, Las Vegas, NV 89130
Telephone - (702) 645-5195 Fax - (702) 645-7704