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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.
Free Quote Application
(personal vehicles):
Please Note:
You will need to fill the
personal information part for each one of the persons that are going to
drive the vehicle. You will have to specify who is the main driver for that
vehicle. You won't have to fill the car's specs part if you are applying for
the same vehicle.
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Name
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Residential Address
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City and Zip Code for
Residential Address
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Postal Address
same as residential
address?
Yes
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City and Zip Code for
Postal Address
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E-mail
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Phones: (provide one,
at least )
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Residential
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Area Code:
Number:
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Mobile
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Area Code:
Number:
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Fax
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Area Code:
Number:
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Job
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Area Code:
Number:
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Birth date
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Month:
Day:
Year:
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Social Security Number
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The main use of this
vehicle is:
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Driver's License Number
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How many miles is your job
from your home?
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Gender
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Your job is
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Are you the main driver of
the vehicle?
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Civil Status
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Brand
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Engine Number
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Model
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Mileage
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Year
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Does it have alarm?
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Plate
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Do you have any actual
policy?
if so, what is
the insurance company?
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You are interested in:
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Lending Institution or Creditor
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Public Liability's Limits:
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Other:
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Financing Term (in months)
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Other:
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Cost of vehicle when new
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Dealer
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Actual cost of vehicle
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Salesperson Name
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Deductible
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Other:
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