Allstate Insurance

As part of the application process, we may collect personal information from persons other than you or other individuals proposed for coverage, including credit reports, claims history, driving record, and insurance history. This information, as well as other personal or privileged information subsequently collected by us, may in certain circumstances be disclosed to third parties without your authorization. You have a right to access and correction with respect to all personal information we collect. If you would like more detailed information in writing about our information collection practices, please let us know.

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Personal Information

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Address: Required

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Contact Information

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Additional Information

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Auto Information (Up to 4 Vehicles)

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Model:

Annual Miles Driven:

Vechicle 2

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Annual Miles Driven:

Vechicle 3

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Vechicle 4

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Privacy Statement

Jack Ruane Agency 816 Baltimore Pike Glen Mills, PA 19342 610-450-0900

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