717auto.com | Ephrata Insurance (Lead Form)

Get Your Customized Auto Insurance Price in 30 seconds or less.

First name

Last name

Phone

Email

Street address

City

State

ZIP code

Drivers

Driver 1

Driver first name

Driver last name

Birthdate

Driver license # (optional)

Vehicles

Vehicle 1

VIN (optional)

Vehicle year

Vehicle make/model

Estimated car value (USD)

Full coverage (Comp + Collision) i

Policy options

Coverage choices

Liability limits

Tort option

Comp/Coll Deductible

Applies only if any vehicle is marked “Full coverage”.

Policy term: 6 months

Policy term

Optional Coverages & Discounts

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By checking this box, you agree to have your auto insurance information verfied by Ephrata Insurance and/or it's affiliates; which may include insurance history, driving record, and other factors. You will receive an automated SMS/text messages from 717auto.com to verify it is you. No purchased is required. Msg & data rates may apply. Reply STOP to cancel, HELP for help.

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717auto.com | Ephrata Insurance

prices as low as online and service as close as main street

1522 W Main St | Ephrata, PA 17522

Phone: 717.431.3800

Text: 717.973.7657

www.717auto.com

Your Selection (option 1)

$—

Enter details to see an estimate.

Monthly (approx.)$—

Pay in full price (save 15%)$—

Liability portion$—

Comp/Coll portion$—

Lower Liability (option 2)

$—

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Monthly (approx.)$—

Pay in full price (save 15%)$—

Liability portion$—

Comp/Coll portion$—

Higher Coverage (option 3)

$—

Enter details to see an estimate.

Monthly (approx.)$—

Pay in full price (save 15%)$—

Liability portion$—

Comp/Coll portion$—

Important: You will receive a final price via text and/or email once your information is verified. If you have any questions you may contact us at 717-431-3800 or info@EphrataInsurance.com