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Important
Note:
This
document is made available to you for your convenience. This document is
only a quote application and does not pretend to cover any of the of the
terms and exclusions of the policy herein presented. This document is not
your policy and does not modify or extend the cover of this policy. the
insurance company, emitter of the quote/policy is subjected to all the
exclusions and terms of the policy. If there are any discrepancy between
this description and the quote or policy, the quote or policy will
prevail. Remember, this is just a quote form.
Please note that due to technical or natural events beyond our control,
like weather, we may not receive your quote. Please confirm that your
application has been received by calling to our toll free number
1-800-981-6545, Monday trough Friday from 8:30 am to 5:00 PM.
We
are going to process your application in our agency labor hour's: Monday
through Friday from 8:30 AM to 5:00 PM, except holydays.
It’s
our honor to serve you,
Nehemías
Toro Insurance Agent.
Explain the type of
business of your company and the uses it gives to its vehicles:
Our website
is under construction. If you need to quote for more than 4 different
types of vehicles, quote again and all you need is to fill in the Name of
Company field, plus the other cars specs.
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Name of Company
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Physical Address
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City and Zip Code of
Physical Address
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Postal Address
Same as physical address?
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City and Zip Code of
Postal Address
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E-Mail
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Phone Number
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area code:
number:
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Vehicle #1
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Year
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Brand
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Model
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Engine Number
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Does it have alarm?
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You are interested in:
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Creditor or Financial
Institution
Does not apply if your are interested in Public Liability Only
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Limit of Public Liability
Does not apply if you are
interested in 'Double Interest' only
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Other:
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Financing Term (in
months)
Does not apply if your are interested in Public Liability Only
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Cost of vehicle when new
Does not apply if your are interested in Public Liability Only
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Dealer
Does not apply if your are interested in Public Liability Only
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Actual Value of Vehicle
Does not apply if your are interested in Public Liability Only
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Sales Person Name
Does not apply if your are interested in Public Liability Only
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Deductible
Does not apply if your are interested in Public Liability Only
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Other:
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What is the quantity of
vehicles that share these same descriptions that you want to include in
this quote?
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Vehicle #2
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Year
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Brand
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Model
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Engine Number
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Does it have alarm?
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You are interested in:
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Creditor or Financial
Institution
Does not apply if your are interested in Public Liability Only
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|
Limit of Public Liability
Does not apply if you are interested in 'Double Interest' only
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Other:
|
Financing Term (in
months)
Does not apply if your are interested in Public Liability Only
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|
Cost of vehicle when new
Does not apply if your are interested in Public Liability Only
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Dealer
Does not apply if your are interested in Public Liability Only
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Actual Value of Vehicle
Does not apply if your are interested in Public Liability Only
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Sales Person Name
Does not apply if your are interested in Public Liability Only
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Deductible
Does not apply if your are interested in Public Liability Only
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Other
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What is the quantity of
vehicles that share these same descriptions that you want to include in
this quote?
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Vehicle #3
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Year
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Brand
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Model
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Engine Number
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Does it have alarm?
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|
|
|
You are interested in:
|
|
Creditor or Financial
Institution
Does not apply if your are interested in Public Liability Only
|
|
Limit of Public Liability
Does not apply if you are interested in 'Double Interest' only
|
Other:
|
Financing Term (in
months)
Does not apply if your are interested in Public Liability Only
|
|
Cost of vehicle when new
Does not apply if your are interested in Public Liability Only
|
|
Dealer
Does not apply if your are interested in Public Liability Only
|
|
Actual Value of Vehicle
Does not apply if your are interested in Public Liability Only
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|
Sales Person Name
Does not apply if your are interested in Public Liability Only
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Deductible
Does not apply if your are interested in Public Liability Only
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Other
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What is the quantity of
vehicles that share these same descriptions that you want to include in
this quote?
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Vehicle #4
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Year
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Brand
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Model
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Engine Number
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Does it have alarm?
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|
|
|
You are interested in:
|
|
Creditor or Financial
Institution
Does not apply if your are interested in Public Liability Only
|
|
Limit of Public Liability
Does not apply if you are interested in 'Double Interest' only
|
Other:
|
Financing Term (in
months)
Does not apply if your are interested in Public Liability Only
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|
Cost of vehicle when new
Does not apply if your are interested in Public Liability Only
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Dealer
Does not apply if your are interested in Public Liability Only
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|
Actual Value of Vehicle
Does not apply if your are interested in Public Liability Only
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Sales Person Name
Does not apply if your are interested in Public Liability Only
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Deductible
Does not apply if your are interested in Public Liability Only
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Other
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What is the quantity of
vehicles that share these same descriptions that you want to include in
this quote?
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