메트로 종합보험- 자동차 견적

(include all cars you or your family members own or lease)

자동차
#1

Vehicle ID# (VIN)

Annual Mileage

견적 요청자
견적 요청자

가입자 정보

주소	Street
	City State Zip Own Rent
전화	Tel Fax (Quote to be Fax to)

운전자 정보
(include all licensed drivers in your household)
운전자 #1	Driver's Name		Drivers License Number (required)
			State:
	Work Address
Relation	Date of Birth	Sex	Marital Status
	(MMDDYYYY)	M F	Married Single	Drivers Ed: Y N

운전자 #2	Driver's Name		Drivers License Number (required)
			State:

Relation	Date of Birth	Sex	Marital Status
	(MMDDYYYY)	M F	Married Single	Drivers Ed: Y N

운전자 #3	Driver's Name		Drivers License Number (required)
			State:

Relation	Date of Birth	Sex	Marital Status
	(MMDDYYYY)	M F	Married Single	Drivers Ed: Y N

운전자 #4	Driver's Name		Drivers License Number (required)
			State:

Relation	Date of Birth	Sex	Marital Status
	(MMDDYYYY)	M F	Married Single	Drivers Ed: Y N

운전자 #5	Driver's Name		Drivers License Number (required)
			State:

Relation	Date of Birth	Sex	Marital Status
	(MMDDYYYY)	M F	Married Single	Drivers Ed: Y N

자동차 #2	Year	Make	Model	Vehicle ID# (VIN)

Annual Mileage			Airbags	Car Alarm
			Y N	Y N

자동차 #3	Year	Make	Model	Vehicle ID# (VIN)

Annual Mileage			Airbags	Car Alarm
			Y N	Y N

자동차 #4	Year	Make	Model	Vehicle ID# (VIN)

Annual Mileage			Airbags	Car Alarm
			Y N	Y N

자동차 #5	Year	Make	Model	Vehicle ID# (VIN)

Annual Mileage			Airbags	Car Alarm
			Y N	Y N

원하시는 커버리지 (Corresponding to coverage in Metro Atlanta)
	Bodily Injury Liability		대인배상
	Property Damage		애물배상
	Medical Payments		의료비
	Uninsured Motorist Bodily Injury		무보험자 대인
	Uninsured Motorist P/D		무보험자 대물

	Collision, Vehicle 1	Yes No	1 자동차 차체 충동
			디덕터볼
	Collision, Vehicle 2	Yes No	2 자동차 차체 충동
			디덕터볼
	Collision, Vehicle 3	Yes No	3 자동차 차체 충동
			디덕터볼
	Collision, Vehicle 4	Yes No	4 자동차 차체 충동
			디덕터볼
	Collision, Vehicle 5	Yes No	5 자동차 차체 충동
			디덕터볼

	Comprehensive, Vehicle 1	Yes No	1 자동차 차체 외 사고
			디덕터볼
	Comprehensive, Vehicle 2	Yes No	2 자동차 차체 외 사고
			디덕터볼
	Comprehensive, Vehicle 3	Yes No	3 자동차 차체 외 사고
			디덕터볼
	Comprehensive, Vehicle 4	Yes No	4 자동차 차체 외 사고
			디덕터볼
	Comprehensive, Vehicle 5	Yes No	5 자동차 차체 외 사고
			디덕터볼

	Substitute Transportation	Yes No	렌트카
	Towing	Yes No	토윙

현제 보험 회사
현제 보험 회사	포로시 #	대인배상

부가 요청
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough fields above, such as additional drivers, vehicles, driver histories, etc..., please enter them here.

Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

Please Note: Insurance coverage cannot be bound without a written binder from our office. Additionally, Please Note: Many insurance carriers use information gathered from you and outside sources about your claim, driving and credit history. This information allows insurance companies to determine accurately the proper price to charge. You are entitled to a free copy of the reports by contacting the appropriate consumer reporting agency within the next 60 days. By filling out this quote you agree to the the above terms.