Allow us to give you a second opinion on your insurance needs, and we will donate $50 to your county 4-H program. What's better? You will be entered in to win one of our quarterly drawings for OSU Football, UK Basketball or Cincinnati Reds tickets too! Simply fill out a form that asks for brief information related to your insurance needs. Paul Hall & Associates will only send you one letter and one email providing a second opinion on your insurance rates. We vow to not harass you. We want to assure you get the most coverage for your insurance dollars. If you choose to purchase home, auto, farm or business policies from us, we will also give you a $50 gift card to LaRosa's! If you are a current client of Paul Hall & Associates, you can also earn a $50 gift card to LaRosa's by referring someone who purchases a policy to us.

What County 4-H Program are we donating for you?*
Adams County 4-H Brown County 4-H Clermont County 4-H Clinton County 4-H Dearborn County 4-H Hamilton County 4-H Highland County 4-H Other

Other *

First Name *

Last Name *

Address *

City *

State *

Zipcode/Postcode *

Email Address *

Current Client of Paul Hall & Associates Insurance:
   YES
   NO

Auto Form

Drivers (including yourself) in household

Driver's Name

Date of Birth

Violations

Good Student

Violations

Good Student

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Violations

Good Students

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Violations

Good Student

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Violations

Good Student

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Vehicles in household

Year

Make/Model

Liability

Comprehensive

Collision

Liability

Comprehensive

Collision

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Liability

Comprehensive

Collition

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Liability

Comprehensive

Collision

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Liability

Comprehensive

Collision

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How did you hear about us?

Only 1 lead per household. Must reside in Ohio, Kentucky, or Indiana. Your information will not be sold to or shared with any third parties. Form must be fully completed for donation to be made.