汽車保險估價 Auto Insurance Quote

開車有保障，安心每一程！
Drive with protection, peace of mind every mile!

Primary Driver Name 主要駕駛人姓名

電郵 Email

生日 Birthday

Month

Day

Year

電話 Phone

性別 Gender

駕照號碼 Driver License #

首次領照年份 First Licensed Year

選擇辦公室 Select Office

您偏好的溝通語言 Preferred Language

微信 WeChat ID

停放地址 Garage Address

郵寄地址 Mailing Address (若與停放地址不同 if different from garage address)

需要新估價的原因 Reason for New Quote

您是如何得知我們的？How did you hear about us?

目前是否已承保? 哪間保險公司? 到期日? Currently insured? which company? expiration date?

請上傳目前保險的保單證明文件 Please upload a copy of the current insurance's declaration page

是否曾有事故紀錄 Any known prior claim?

若曾有事故或是罰單，請寫下年份及描述 Please provide the year and a brief description of any past claims & traffic tickets:

引擎號 VIN#

目前總里程數 Current Odometer Reading

購買日期 Purchase Date

用途 Usage

車輛是擁有、貸款還是租賃？Is the vehicle own / loan / lease?

車輛註冊所有人 Register Owner of the vehicle

折扣 Discount

好學生折扣 Good Student Discount

科學 / 工程折扣 Science / Engineer Discount

AAA / Costco / Sam's Club 會員折扣 Membership Discount

其他車輛（如有需要）Additional Vehicle (if needed)

引擎號 VIN#

目前總里程數 Current Odometer Reading

購買日期 Purchase Date

用途 Usage

車輛是擁有、貸款還是租賃？Is the vehicle own / loan / lease?

車輛註冊所有人 Register Owner of the vehicle

引擎號 VIN#

目前總里程數 Current Odometer Reading

購買日期 Purchase Date

用途 Usage

車輛是擁有、貸款還是租賃？Is the vehicle own / loan / lease?

車輛註冊所有人 Register Owner of the vehicle

其他駕駛人（如有需要）Additional Drivers (if needed)

姓名 Full Name

生日 Birthday

性別 Gender

關係 Relationship

駕照號碼 Driver License #

首次領照年份 First Licensed Year

姓名 Full Name

生日 Birthday

性別 Gender

關係 Relationship

駕照號碼 Driver License #

首次領照年份 First Licensed Year

備註 Additional Notes

汽車保險估價 Auto Insurance Quote

開車有保障，安心每一程！ Drive with protection, peace of mind every mile!

開車有保障，安心每一程！
Drive with protection, peace of mind every mile!