Automobile Insurance Quote
We would like to provide you with a free, no-obligation automobile insurance quote.  Please provide as much information possible for the most accurate quote.  This information will be kept confidential and will be used for quote purposes only.

Personal Information
Date of Quote Request required field
Name
Street Address
City
State
Zip
Daytime Phone
Night Phone
Best Time To Call AM PM
Email Address


Current Auto Insurance Information
Company Name (not agency)
Policy Expiration Date
Premium Amount Term 3 Months 6 Months 1 Year


Vehicle Information for Car #1
(Include all cars you or your family members own or lease)
Year
Make
Model
Body Type
Vehicle ID# (VIN)
Name of Title Holder
Annual Mileage
Airbags Y N
Car Alarm Y N
If vehicle is kept at an address other than that listed above, please indicate below.
Location City
State
Zip


Vehicle Information for Car #2
(Include all cars you or your family members own or lease)
Year
Make
Model
Body Type
Vehicle ID# (VIN)
Name of Title Holder
Annual Mileage
Airbags Y N
Car Alarm Y N
If vehicle is kept at an address other than that listed above, please indicate below.
Location City
State
Zip


Vehicle Information for Car #3
(Include all cars you or your family members own or lease)
Year
Make
Model
Body Type
Vehicle ID# (VIN)
Name of Title Holder
Annual Mileage
Airbags Y N
Car Alarm Y N
If vehicle is kept at an address other than that listed above, please indicate below.
Location City
State
Zip


Vehicle Information for Car #4
(Include all cars you or your family members own or lease)
Year
Make
Model
Body Type
Vehicle ID# (VIN)
Name of Title Holder
Mileage
Airbags Y N
Car Alarm Y N
If vehicle is kept at an address other than that listed above, please indicate below.
Location City
State
Zip Code


Choose either Bodily Injury and Property Damage, or a Single Limit
Bodily Injury
Property Damage
OR
Combined Single Limit


Deductibles and Misc.
Car #1 Comprehensive Deductible Collision Deductible Towing Y Loss of Use Y
Car #2 Comprehensive Deductible Collision Deductible Towing Y Loss of Use Y
Car #3 Comprehensive Deductible Collision Deductible Towing Y Loss of Use Y
Car #4 Comprehensive Deductible Collision Deductible dtowing Y Loss of Use Y


Driver Information
#1 Driver's Name
DL# State Years Licensed
Relation Date of Birth Sex M F Marital Status Married Single
Courses completed in Last 3 years? Drivers Ed Y N Accident Prevention Y N

#2 Driver's Name
DL# State Years Licensed
Relation Date of Birth Sex M F Marital Status Married Single
Courses completed in Last 3 years? Drivers Ed Y N Accident Prevention Y N

#3 Driver's Name
DL# State Years Licensed
Relation Date of Birth Sex M F Marital Status Married Single
Courses completed in Last 3 years? Drivers Ed Y N Accident Prevention Y N

#4 Driver's Name
DL# State Years Licensed
Relation Date of Birth Sex M F Marital Status Married Single
Courses completed in Last 3 years? Drivers Ed Y N Accident Prevention Y N


Driver History
Please list ANY convictions for ANY driver convicted of moving traffic violations in the past 3 years.
Driver Date Type of Conviction
Fine Speed Over Limit (mph)
Driver Date Type of Conviction
Fine Speed Over Limit (mph)
Driver Date Type of Conviction
Fine Speed Over Limit (mph)
Driver License Suspended or Revoked? Suspended Revoked
DUI Conviction For Alcohol Drugs
Driver License Suspended or Revoked? Suspended Revoked
DUI Conviction For Alcohol Drugs
Driver License Suspended or Revoked? Suspended Revoked
DUI Conviction For Alcohol Drugs

Please list ANY driver involved in an accident, regardless of fault, in the last 5 years.
Driver
Date
Description Cost Fine
Injuries Y N At Fault Y N
Driver Date
Description Cost Fine
Injuries Y N At Fault Y N
Driver Date
Description Cost Fine
Injuries Y N At Fault Y N


Additional Comments
Please use the space below to provide any additional information that you feel would be helpful in the preparation of this quote.


About Brenneis Insurance


Brenneis Insurance Agency, Inc. has been incorporated and in business in Tekamah, Nebraska since 1979.  Brenneis Insurance is a member of the The Independent Insurance Agents of Nebraska and has numerous relationships with Independent carriers and national brokers.

Kevin Brenneis, CIC is owner and principal of Brenneis Insurance Agency, Inc. Kevin has been in the insurance industry since 1996 and received his Certified Insurance Counselor designation in 2003.



  




 

Get a Quote


Brenneis Insurance Agency, Inc. is a full service agency offering many types of insurance coverage.  To be of better service to you, we have equipped this site with links for you to submit information to receive auto, home, life, disability, and health insurance quotes.    <<read more>>

If you would like to receive commercial insurance or farm quotes, you will need to contact Kevin Brenneis at the agency or send him an email with your contact information so he can gather the appropriate information.


Get a Quote here!
Click here to access our Quote Forms.



Kevin Brenneis, CIC

Kevin Brenneis, CIC is owner and Principal of Brenneis Insurance Agency, Inc. Brenneis Insurance has been in business in Tekamah, Nebraska since 1979.

Contact Us Now

Brenneis Insurance Agency

129 S. 13th Street
Tekamah, NE  68061

Phone:  402.374.1911
Mobile:  402.870.0693
Fax:        402.374.1915

Email Us

World Class Customer Service

Our office is fully staffed with trained professionals who are also licensed agents and customer service reps.  Lucille Eriksen, Kristi Gross, Sheryl Stansberry and Cathy Zink are available to help you with all of your personal insurance needs. 



 We all look forward to serving you!

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