Request Information / Quote

If you would like more information about policies offered by the AG/Gaesser Agency, please complete this form and hit "Submit" at the bottom of the page. Your information will be sent to us and we’ll contact you shortly with a reponse.

Required fields are marked with an asterisk (*).

General Information

Name * First	* Last

* Address		Apt No.

* City/Town	* State	* ZIP Code

* E-mail		* Phone

Best time of day to contact:

Complete sections for any of the following: Automotive, Homeowners, Renters, and Business.

Automotive

Complete this section if you’d like information about automobile insurance.
Enter ages of up to five drivers -- , , , ,
Enter information for up to five vehicles
Vehicle	Year	Make	Model
Primary:
Vehicle #2:
Vehicle #3:
Vehicle #4:
Vehicle #5:
More than five drivers or vehicles in this household?

Homeowners

Complete this section if you’d like information about property insurance for homeowners.
Year the home was built:
Square footage:	sq. ft.
Replacement cost or current policy level:	$
Liability coverage desired:
Deductible desired:

Renters

Complete this section if you’d like information about property insurance for renters.
Replacement coverage desired:	$
Liability coverage desired:
Deductible desired:

Business

Complete this section if you’d like information about our business policies.
Name of your business:
Year founded / years in business:
Describe your business, and/or the type of coverage you would like:

The information you submit here is only to provide us with initial information regarding your policy. In many cases, we will need to speak with you before we can offer a quote.

PRIVACY POLICY: The AG/Gaesser Agency, Inc. will not share your personal information, including e-mail and phone number, with any other parties, except when directly related to an insurance policy and the information must be shared.

1220 Fairport Road, Fairport, New York 14450, Phone 585-381-0394, Fax 585-381-6076